[Remote] Payment Integrity Analyst II

Note: The job is a remote job and is open to candidates in USA. CorVel Corporation is a certified Great Place to Work® Company that focuses on healthcare payment accuracy and transparency. The Payment Integrity Analyst II is responsible for reviewing and completing claim audits in accordance with client policies and CMS guidelines, utilizing clinical judgment and analytical skills for effective audit performance.ResponsibilitiesReviews, analyzes, and completes internal audits and/or appeals in accordance with client policy, CMS guidelines and industry standards in clear and professional written communicationUse 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 auditsUtilize applicable tools and resources to complete internal audits and/or appealsTimely completion of internal audits and/or appealsAttends clinical team meetings, company meetings, educational opportunities/trainings, and other meetingsAdditional duties as assignedSkillsAbility to use clinical judgment and analytical skills for claim audit reviewKnowledge of CMS/commercial payer policies, claims processing and reimbursements, IDC-10 Coding, and DRG ValidationFamiliarity with healthcare revenue cycle and coordination of benefitsProficiency in Microsoft Office, especially using pivot tables in Excel as well as and database toolsExcellent written and verbal communication skillsStrong interpersonal skills across all levels; comfortable interfacing with clients and the C-SuiteAbility to work on several concurrent tasks and prioritize workload to meet designated deadlinesAdvanced problem-solving and data analysis capabilitiesProven track record of delivering actionable resultsStrong attention to detailMust maintain a current LPN, LVN and/or RN licensurePrevious 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 review1+ years healthcare revenue cycle1+ years of relevant experience or equivalent combination of education and work experience1+ years hospital bill auditBachelor's degree in healthcare or related field preferredPreferred experience with health insurance denials and/or appeals, payer audits, or vendor auditsBenefitsMedical (HDHP) w/PharmacyDentalVisionLong Term DisabilityHealth Savings AccountFlexible Spending Account OptionsLife InsuranceAccident InsuranceCritical Illness InsurancePre-paid Legal InsuranceParking and Transit FSA accounts401KROTH 401KPaid time offCompany OverviewCorVel is a nationally recognized claims management and managed care provider with over 30 years of experience in the industry. It was founded in 1987, and is headquartered in Irvine, California, USA, with a workforce of 1001-5000 employees. Its website is https://www.corvel.com/.



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