Payment Integrity SME - Remote
Job Summary
To enhance payment integrity analytics, the part-time temporary Payment Integrity SME - Remote will identify overpayment opportunities, develop and improve audit concepts, and collaborate with various teams to translate healthcare billing expertise into scalable solutions, working up to 20 hours per week for a project duration of 4-6 months.
Key responsibilities
- Develop new payment integrity concepts by researching overpayment scenarios and converting findings into automated audit concepts
- Analyze no-finding audits to identify underlying reasons and categorize them to improve selection accuracy
- Identify new opportunities by analyzing claims and billing patterns to address potential payment leakage
Required qualifications
- Minimum of 5 years of experience in healthcare claims auditing, medical coding, or related healthcare operations
- Demonstrated experience with inpatient and/or outpatient claims, including coding and reimbursement rules
- Strong knowledge of healthcare coding guidelines and common billing error scenarios
- Ability to interpret claim-level data and validate audit opportunities
- Experience collaborating with analytics and operational teams for audit concept development
Complete Job Description
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