Remote Healthcare Payment Integrity Consultant

Job is Expired

Location: Nationwide

Compensation: To Be Discussed

Staff Reviewed: Wed, May 05, 2021

Job Category: Healthcare

Remote Level: 100% Remote

Employer Type: Employer

Career Level: Experienced

Job Summary

A professional services firm specializing in IT, healthcare, and accounting is filling a position for a Remote Payment Integrity Consultant.

Core Responsibilities Include:

  • Ooverseeing medical coding for a health plan to ensure compliance with AHIMA standards
  • Applying knowledge of clinical and coding (and claims processing systems) to audit medical and billing documentation to confirm unsupported charges and payment inaccuracies
  • Analyzing and interpreting a health plan's product benefits, fee schedules, claims edits, provider agreements, and claims processing rules to build algorithms for payment integrity library internally to identify overpayments

Required Skills:

  • Ability to analyze very large data sets to identify likely healthcare claims payment inaccuracies
  • Healthcare analytics experience specializing in provider fraud, waste, and error detection and analytic software development
  • Ability to oversee and implement operations related to the payment audit programs
  • Ability to ensure payment processes are compliant with regulatory requirements and present process recommendations

COMPLETE JOB DESCRIPTION

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