Oregon Licensed Payment Integrity Clinician

Job Summary

A company is looking for a Payment Integrity Clinician I (Remote).

Key Responsibilities

• Apply clinical expertise to validate compliance with medical and reimbursement policies
• Review medical records and documentation to ensure alignment with regulations and standards
• Conduct claim reviews for accurate payment and appropriate clinical justification

Required Qualifications

• Associate's or Bachelor's degree in Healthcare
• 3+ years of experience in a clinical setting, health insurance, coding/claims review, or case management
• Unrestricted license or certification in OR, WA, ID, or UT within a health or human services discipline
• Current unrestricted Registered Nurse (RN) license or Bachelor's degree in a health-related field
• Minimum 3 years of direct clinical care experience