Payment Integrity Analyst II

CorVel Career Site • Fort Worth, TX

23h • Remote

About The Position

The Payment Integrity Analyst is responsible for accurately reviewing and completing pre- and post pay claim audits based on client, policy, industry standards and/or CMS guidelines. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Reviews, analyzes, and completes internal audits and/or appeals in accordance with client policy, CMS guidelines and industry standards in clear and professional written communication Use clinical judgement to appropriately interpret and apply client policies along with CMS guidelines as it relates to reviews done by CERIS such as itemized bill, DRG and/or specialty audits Utilize applicable tools and resources to complete internal audits and/or appeals Timely completion of internal audits and/or appeals Attends clinical team meetings, company meetings, educational opportunities/trainings, and other meetings Additional duties as assigned KNOWLEDGE & SKILLS: Ability to use clinical judgment and analytical skills for claim audit review Knowledge of CMS/commercial payer policies, claims processing and reimbursements, IDC-10 Coding, and DRG Validation Familiarity with healthcare revenue cycle and coordination of benefits Proficiency in Microsoft Office, especially using pivot tables in Excel as well as and database tools Excellent written and verbal communication skills Strong interpersonal skills across all levels; comfortable interfacing with clients and the C-Suite Ability to work on several concurrent tasks and prioritize workload to meet designated deadlines Advanced problem-solving and data analysis capabilities Proven track record of delivering actionable results Strong attention to detail EDUCATION & EXPERIENCE: Must maintain a current LPN, LVN and/or RN licensure Previous experience in one or more of the following areas required: Medical bill auditing Experience in the acute clinical areas of facilities in O.R., I.C.U., C.C.U., E.R., Telemetry, Medical/Surgical, OB or L&D, Geriatrics and Orthopedics Knowledge of worker's compensation claims process Prospective, concurrent and retrospective utilization review 1+ years healthcare revenue cycle 1+ years of relevant experience or equivalent combination of education and work experience 1+ years hospital bill audit Bachelor’s degree in healthcare or related field preferred

Requirements

• Must maintain a current LPN, LVN and/or RN licensure
• Previous experience in one or more of the following areas required: Medical bill auditing Experience in the acute clinical areas of facilities in O.R., I.C.U., C.C.U., E.R., Telemetry, Medical/Surgical, OB or L&D, Geriatrics and Orthopedics Knowledge of worker's compensation claims process Prospective, concurrent and retrospective utilization review
• 1+ years healthcare revenue cycle
• 1+ years of relevant experience or equivalent combination of education and work experience
• 1+ years hospital bill audit
• Ability to use clinical judgment and analytical skills for claim audit review
• Knowledge of CMS/commercial payer policies, claims processing and reimbursements, IDC-10 Coding, and DRG Validation
• Familiarity with healthcare revenue cycle and coordination of benefits
• Proficiency in Microsoft Office, especially using pivot tables in Excel as well as and database tools
• Excellent written and verbal communication skills
• Strong interpersonal skills across all levels; comfortable interfacing with clients and the C-Suite
• Ability to work on several concurrent tasks and prioritize workload to meet designated deadlines
• Advanced problem-solving and data analysis capabilities
• Proven track record of delivering actionable results
• Strong attention to detail

Nice To Haves

• Bachelor’s degree in healthcare or related field preferred
• Preferred experience with health insurance denials and/or appeals, payer audits, or vendor audits

Responsibilities

• Reviews, analyzes, and completes internal audits and/or appeals in accordance with client policy, CMS guidelines and industry standards in clear and professional written communication
• Use clinical judgement to appropriately interpret and apply client policies along with CMS guidelines as it relates to reviews done by CERIS such as itemized bill, DRG and/or specialty audits
• Utilize applicable tools and resources to complete internal audits and/or appeals
• Timely completion of internal audits and/or appeals
• Attends clinical team meetings, company meetings, educational opportunities/trainings, and other meetings
• Additional duties as assigned

Benefits

• Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level