Tech Stack

Description

You will join the Payment Integrity team to support process improvement and issue resolution in the claims environment. Your role involves leveraging claims infrastructure and cross-functional collaboration to translate stakeholder friction into actionable solutions, driving payment integrity opportunities.

Requirements

• Bachelor's degree or 4+ years commensurate experience
• 3+ years claims processing, coding, auditing or healthcare claims operations
• 3+ years medical coding in payment integrity
• Medical coding certification (CPC, COC, CCS, RHIT, RHIA)
• 2+ years deriving business insights from datasets

Responsibilities

• Serve as subject matter expert for reimbursement policies and payment integrity edits
• Respond to inquiries and disputes regarding policies and edits
• Research coding rules and provide input into reimbursement policy language
• Identify payment integrity opportunities and translate into business requirements
• Analyze data to proactively identify thematic areas for process improvement