Senior Payment Integrity Specialist

Job Summary

A company is looking for a Sr. Payment Integrity Specialist - Data Mining.

Key Responsibilities

• Lead investigations to validate correct reimbursement based on medical and payment policy
• Analyze claim inventory and collaborate on client-specific business rules
• Identify and recommend process improvements to enhance accuracy and outcomes

Required Qualifications

• Minimum of eight (8) years of experience in healthcare, particularly in claims processing or payment integrity
• Advanced proficiency with Excel and experience working with large data sets
• Knowledge of medical billing codes and payment methodologies for various providers
• Ability to analyze payment policies for Commercial, Managed Care, Medicare, and Medicaid
• Experience in maintaining an audit-ready work product with minimal supervision