Payment Integrity Specialist

Job Summary

Ensuring the accuracy and compliance of claims and payments, the full-time remote Payment Integrity Specialist will manage payment audits, identify discrepancies, and drive process improvements while collaborating with cross-functional teams.

Key responsibilities

• Review claims and encounters against contract terms and guidelines to confirm payment accuracy
• Identify and document overpayments, underpayments, and improper payments, recommending corrective actions
• Analyze claims data to detect trends and collaborate with stakeholders to operationalize improvements

Required qualifications

• Bachelor's degree in finance, healthcare administration, business, or a related field; relevant certification is a plus
• 3+ years of experience in payment integrity, claims auditing, or related fields
• Working knowledge of healthcare claims lifecycle and coding systems (CPT, HCPCS, ICD-10, DRG)
• Exposure to value-based and managed care arrangements, with Medicaid experience preferred
• Strong Excel skills; proficiency in SQL or claims-data querying is strongly preferred