Ensuring the accuracy and compliance of claims and payments, the full-time remote Payment Integrity Specialist will manage payment audits, identify discrepancies, and drive process improvements while collaborating with cross-functional teams. Key responsibilities Review claims and encounters against contract terms and guidelines to confirm payment accuracy Identify and document overpayments, underpayments, and improper payments, recommending corrective actions Analyze claims data to detect trends and collaborate with stakeholders to operationalize improvements Required qualifications Bachelor's degree in finance, healthcare administration, business, or a related field; relevant certification is a plus 3+ years of experience in payment integrity, claims auditing, or related fields Working knowledge of healthcare claims lifecycle and coding systems (CPT, HCPCS, ICD-10, DRG) Exposure to value-based and managed care arrangements, with Medicaid experience preferred Strong Excel skills; proficiency in SQL or claims-data querying is strongly preferred
Payment Integrity Specialist in workfromhome at Unknown Company
This position is listed as contract and able to be worked remotely.