Payment Integrity Auditor

Job Summary

A company is looking for a Payment Integrity Auditor.

Key Responsibilities:

• Conduct complex audits to identify claim overpayments and ensure compliance with billing and coding parameters
• Evaluate and audit medical and billing records, and interact with providers to clarify issues and negotiate resolutions
• Document discrepancies, initiate claim adjustments, and serve as the liaison for vendor claims processing

Qualifications:

• Bachelor's degree or equivalent
• Minimum 3 years of relevant experience in healthcare auditing, coding, or compliance
• Preferred certifications include RHIA, RRA, CCS, ART, CPC, CORT, or RN
• Working knowledge of healthcare provider audit methods and payment methodologies
• Strong proficiency in MS Excel and audit tools