Payment Integrity Analyst II

📋 Description

• Review, analyze, and complete pre- and post-payment claim audits and appeals per client policies
• Apply clinical judgment to evaluate documentation and determine claim appropriateness and accuracy.
• Interpret payer policies and regulatory requirements across itemized bills, DRG reviews, and
• Use systems, tools, and resources to conduct audits, appeals, and payment integrity reviews.
• Analyze healthcare claims and supporting documentation to identify discrepancies and payment issues.
• Communicate audit findings clearly in written and verbal formats.

🎯 Requirements

• Maintain an active LPN, LVN, and/or RN license.
• Bring at least 1 year of relevant professional experience or equivalent education/experience.
• At least 1 year of healthcare revenue cycle and hospital bill auditing experience.
• Strong knowledge of claims processing, ICD-10 coding, DRG validation, COB, and revenue cycles.
• Experience in medical bill auditing and/or clinical environments (OR, ICU, ED, telemetry, etc.).
• Experience with health insurance denials/appeals, payer or vendor audits, and utilization review

🎁 Benefits

• Salary range: $66,941–$101,258, with compensation based on location, experience, qualifications
• Remote work arrangement.
• Medical, dental, and vision insurance options.
• Health Savings Account (HSA) and Flexible Spending Account (FSA).
• Long-term disability and life insurance.
• Accident and critical illness insurance.