Payment Integrity Analyst II

CERIS • Fort Worth, TX

14h • 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.

Requirements

• 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
• 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

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
• Number of Employees: 101-250 employees