The Payment Integrity Analyst is responsible for accurately reviewing and completing pre- and post-pay claim audits based on client policies, industry standards, and CMS guidelines.
The role supports internal audits and appeals, applying clinical judgment, policy interpretation, and claim review expertise to help ensure accurate healthcare payments.
Requirements & Qualifications
- Current LPN, LVN, or RN licensure required
- 1+ years of healthcare revenue cycle experience
- 1+ years of relevant experience or equivalent combination of education and work experience
- 1+ years of hospital bill audit experience
- Previous experience in one or more of the following areas:
- Medical bill auditing
- Acute clinical experience in O.R., I.C.U., C.C.U., E.R., Telemetry, Medical/Surgical, OB or L&D, Geriatrics, or Orthopedics
- Workers' compensation claims process
- Prospective, concurrent, or retrospective utilization review
- Bachelor's degree in healthcare or related field preferred
- Preferred experience with health insurance denials and/or appeals, payer audits, or vendor audits
- Knowledge of CMS and commercial payer policies, claims processing and reimbursements, ICD-10 coding, and DRG validation
- Familiarity with healthcare revenue cycle and coordination of benefits
- Proficiency in Microsoft Office, especially Excel pivot tables, and database tools
- Strong written and verbal communication skills
- Strong interpersonal, problem-solving, analytical, and organizational skills
- Ability to manage multiple tasks and meet deadlines
Benefits & Perks
- Medical (HDHP) with 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
- 401(k)
- Roth 401(k)
- Paid time off
Location
Fort Worth, Texas, US
Employment Type
Full-time
Experience Level
Associate
Salary Range
$66,941 - $101,258
Remote work allowed
No
Posted
3 months ago