[Hiring] Payment Integrity Analyst II @CorVel Career Site

Role Description

The Payment Integrity Analyst is responsible for accurately reviewing pre and post pay claim audits based on client, policy, industry standards and/or CMS guidelines. This is a remote position.

• Reviews, analyzes, and completes internal audits and/or appeals in accordance with client policy, CMS guidelines and industry standards in clear and professional written communication.
• Ability to use clinical judgement and analytical skills to appropriately review documentation submitted for claim audits.
• Utilize clinical judgement to appropriately interpret and apply client policies along with CMS guidelines as it relates to reviews done by CERIS such as itemized bill, DRG and/or specialty audits.
• Utilize applicable tools and resources to complete internal audits and/or appeals.
• Timely completion of internal audits and/or appeals.
• Attends Clinical Team Meetings, All Company Meetings, Education Opportunities, Trainings, and other potential meetings.
• Additional duties as assigned.

Qualifications

• Ability to demonstrate understanding of CMS and commercial payer policy in written and verbal format.
• Strong understanding of claims processing, ICD-10 Coding, DRG Validation, Coordination of Benefits.
• Strong understanding of healthcare revenue cycle and claims reimbursement.
• Proficient in Microsoft Office including Pivot Tables and Database Management.
• Comfortable interfacing with clients and the C-Suite.
• Demonstrate ability to manage multiple projects, set priorities and adhere to committed schedule.
• Strong interpersonal skills and adaptive communication style, complex problem solving skills, drive for results, innovative.
• Excellent written and verbal communication skills.
• Proven track record of delivering concrete results in strategic projects/programs.
• Strong analytical and modeling ability and distilling data into actionable results.
• Superb attention to detail and ability to deliver results in a fast paced and dynamic environment.

Requirements

• Must maintain a current LPN, LVN and/or RN licensure.
• Preferred experience with health insurance denials and/or appeals, payer audits, or vendor audits.
• Previous experience in one or more of the following areas required:
• Medical bill auditing.
• Experience in the acute clinical areas of facilities in O.R., I.C.U., C.C.U., E.R., Telemetry, Medical/Surgical, OB or L&D, Geriatrics and Orthopedics.
• Knowledge of worker's compensation claims process.
• Prospective, concurrent and retrospective utilization review.
• Bachelor’s degree in healthcare or related field preferred.
• 1+ years healthcare revenue cycle.
• 1+ years of relevant experience or equivalent combination of education and work experience.
• 1+ years hospital bill audit.

Benefits

• CorVel uses a market based approach to pay and our salary ranges may vary depending on your location.
• Pay Range: $66,941 – $101,258.
• A comprehensive benefits package is available for full-time regular employees and includes:
• Medical (HDHP) w/Pharmacy.
• Dental.
• Vision.
• Long Term Disability.
• Health Savings Account.
• Flexible Spending Account Options.
• Life Insurance.
• Accident Insurance.
• Critical Illness Insurance.
• Pre-paid Legal Insurance.
• Parking and Transit FSA accounts.
• 401K, ROTH 401K.
• Paid time off.