Payment Integrity Specialist Certification Required

Job Summary

Supporting payment accuracy and compliance, the full-time remote Payment Integrity Policy Specialist II will analyze and interpret payment policies and regulatory changes, ensuring accurate claims adjudication and operational guidance while collaborating with various stakeholders.

Key responsibilities

• Analyze new and updated Payment Integrity policies and regulatory changes impacting claims processing
• Collaborate with Claims and Configuration Operations to validate policy interpretations and support accurate adjudication outcomes
• Develop clear policy summaries and operational guidance for Claims Operations and related business units

Required qualifications

• Bachelor's degree and 2-4 years of related experience in health insurance, claims operations, or payment integrity
• Working knowledge of healthcare claims processing, benefit/payment logic, and reimbursement methodologies
• Proficiency with Microsoft Office applications and specialized claims and policy support systems
• Experience with Payment Integrity policy interpretation and claims configuration preferred
• CCS, RHIT, CPC, or equivalent certification required