Payment Integrity Specialist

Job Summary

Responsible for reviewing and analyzing underpayment records and managed care contracts, the full-time Payment Integrity Specialist will ensure compliance with contract terms and maximize reimbursement while working remotely.

Key responsibilities

• Review and maintain underpayment records and managed care contracts to ensure accurate billing and reimbursement
• Develop and document standard operating procedures to ensure consistency in claim adjudication and compliance
• Conduct extensive research and analysis on managed care issues, facilitating communication and education with internal departments and payors

Required qualifications

• Associate degree in healthcare or business-related field, or a minimum of three years of prior healthcare revenue cycle experience
• Experience working with Excel spreadsheets is required
• Minimum of two years of prior healthcare experience with an understanding of healthcare reimbursement is preferred
• Ability to meet standard productivity requirements before transitioning to a home-based position