Payment Integrity Clinician - Remote

Overview

The Payment Integrity Clinician is responsible for identifying and resolving issues related to provider claims data, ensuring proper payment, and enhancing member satisfaction through effective review processes.

In Short

• Identify issues with professional and facility provider claims data.
• Implement Payment Integrity strategies for pre-payment and retrospective reviews.
• Analyze medical documentation, itemized bills, and claims data.
• Educate providers on proper billing practices.
• Monitor and analyze healthcare service delivery.
• Develop positive relationships with internal and external customers.
• Act as a resource for less experienced colleagues.
• Drive assigned projects to completion.
• Practice within ethical principles and compliance standards.
• Work primarily remotely while adhering to company policies.

Requirements

• Associate's Degree in Nursing required; Bachelor's preferred.
• 3-5 years of related experience in a clinical setting required.
• Experience in Managed Care and coding preferred.
• Registered Nurse license required.
• Certified Medical Coder preferred.
• Ability to solve complex issues with minimal direction.
• Strong analytical skills.
• Excellent communication skills.
• Ability to work independently and as part of a team.
• Commitment to compliance with HIPAA and company policies.

Benefits

• Competitive salary range.
• Comprehensive health benefits.
• Opportunities for professional development.
• Flexible work environment.
• Supportive company culture.
• Access to resources for maintaining work-life balance.
• Employee assistance programs.
• Retirement savings plans.
• Potential for career advancement.
• Inclusive work environment.