Payment Integrity Professional

Become a part of our caring community and help us put health first
 The Payment Integrity Professional 2 contributes to overall cost reduction by utilizing code editing guidelines and data anomalies to ensure correct claim payment. The Payment Integrity Professional 2 work assignments require in depth research, cross departmental collaboration and independent determination of the appropriate courses of action.

Ready for a career move? The Payment Integrity Professional 2 contributes to overall cost reduction by utilizing coding knowledge to identify/validate new code edit opportunities in a timely fashion to ensure claims process correctly the first time. Expert level of coding knowledge specific to Medicare and Medicaid guidelines is a must. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.

Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Fosters relationships between Code Edit Management, internal stakeholders and multiple external code editing vendors. Drives process improvements and ensures successful run of business. Follows established guidelines/procedures. This position is a Remote, Work At Home role.

Use your skills to make an impact
 

WORK STYLE: 100% remote/work at home.

WORK HOURS: Typical business hours are Monday-Friday, 8 hours/day, 5 days/week. Associates are expected to start each day between 6AM-9AM in their own time zone.

What you need for success! Required Qualifications

• Certified Professional Coder with either AHIMA or AAPC certification

• Minimum of 2 years of experience utilizing coding guidelines, submitting, reading and/or interpreting claims

• Distinguished knowledge of American Medical Association Current Procedural Terminology (CPT®), Healthcare Common Procedure Coding System (HCPCS) and International Classification of Diseases (ICD) code sets.

• Exceptional understanding of Centers for Medicare & Medicaid Services (CMS) guidelines, state Medicaid guidelines, correct-coding initiatives, national benchmarks and industry standards.

• Working knowledge of Microsoft Office Programs Word, PowerPoint, and Excel

• Proficient in managing diverse priorities, adept at swiftly transitioning between tasks based on urgency and demand

• Analytical thinking

• Strong attention to detail

• Can work independently and determine appropriate courses of action

• Ability to operate in a fast paced, agile, metric driven operational setting

• Capacity to maintain confidentiality

• Excellent communication skills both written and verbal

• Comfortable presenting to a large audience

• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

What you need to STAND OUT in the crowd! Preferred Qualifications

• Experience using code editing vendor tools

• Experience leading projects and/or processes

• Ability …