Payment Integrity Specialist Certification Required

Supporting payment accuracy and compliance, the full-time remote Payment Integrity Policy Specialist II will analyze and interpret payment policies and regulatory changes, ensuring accurate claims adjudication and operational guidance while collaborating with various stakeholders. Key responsibilities Analyze new and updated Payment Integrity policies and regulatory changes impacting claims processing Collaborate with Claims and Configuration Operations to validate policy interpretations and support accurate adjudication outcomes Develop clear policy summaries and operational guidance for Claims Operations and related business units Required qualifications Bachelor's degree and 2-4 years of related experience in health insurance, claims operations, or payment integrity Working knowledge of healthcare claims processing, benefit/payment logic, and reimbursement methodologies Proficiency with Microsoft Office applications and specialized claims and policy support systems Experience with Payment Integrity policy interpretation and claims configuration preferred CCS, RHIT, CPC, or equivalent certification required