Healthcare Payment Integrity Specialist

Job Summary

A company is looking for a Healthcare Payer Payment Integrity Specialist.

Key Responsibilities:

• Evaluate variances on paid claims
• Interpret and calculate payer contract reimbursement methodology
• Initiate timely appeals and reconsideration with payers

Required Qualifications:

• Bachelor's degree in analytics, healthcare administration, or related field, or equivalent work experience
• Experience in commercial insurance collections, including claims submission and follow-up
• Understanding of explanation of benefits
• Familiarity with revenue cycle structure and processes, including knowledge of CPT and HCPCS codes