Payment Integrity Analyst II

CERIS•Fort Worth, TX

2h•$66,941 - $101,258•Remote

About The Position

The Payment Integrity Analyst is responsible for accurately reviewing pre and post pay claim audits based on client, policy, industry standards and/or CMS guidelines. This is a remote position.

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 demonstrate understanding of CMS and commercial payer policy in written and verbal format
Strong understanding of claims processing, ICD-10 Coding, DRG Validation, Coordination of Benefits
Strong understanding of healthcare revenue cycle and claims reimbursement
Proficient in Microsoft Office including Pivot Tables and Database Management
Comfortable interfacing with clients and the C-Suite
Demonstrate ability to manage multiple projects, set priorities and adhere to committed schedule
Strong interpersonal skills and adaptive communication style, complex problem solving skills, drive for results, innovative
Excellent written and verbal communication skills
Proven track record of delivering concrete results in strategic projects/programs
Strong analytical and modeling ability and distilling data into actionable results
Superb attention to detail and ability to deliver results in a fast paced and dynamic environment

Nice To Haves

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

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
Ability to use clinical judgement and analytical skills to appropriately review documentation submitted for claim audits
Utilize 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, All Company Meetings, Education Opportunities, Trainings, and other potential meetings
Additional duties as assigned