Build a career with purpose. Join a mission-driven team focused on creating a person-centered and economically sustainable health care system.
As a member of the Post Service Claim Review team, the Payment Integrity Nurse I conducts post-service reviews of claims in prepayment, post-payment, or audit capacity to ensure appropriate clinical review, reimbursement of claims, and coding accuracy. The role applies internal medical and reimbursement policies, along with correct coding guidelines based on national standards, to support claim review and determination.
This position uses clinical expertise to help ensure health care dollars are spent appropriately and ethically while protecting patients and the integrity of the health care system.
Qualifications
- Associate's or bachelor's degree in healthcare
- Minimum 3 years of experience in a clinical setting, health insurance, coding/claims review, case management, or an equivalent combination of education and experience
- Unrestricted licensure or certification in OR, WA, ID, or UT in a health or human services discipline that allows independent assessment within scope of practice
- Minimum 3 years of direct clinical care experience
- Bachelor's degree or higher in a health or human services-related field, or current unrestricted RN license
- Preferred: CPC certification through AAPC or AHIMA
Skills and attributes
- Knowledge of medical and surgical procedures and other healthcare practices
- Ability to apply clinical expertise to ensure compliance with medical and reimbursement policies
- Ability to read and interpret medical records and patient data
- Strong computer skills, including Microsoft Word, Excel, and PowerPoint
- Strong verbal, written, interpersonal, and customer service skills
- Strong research, analytical, math, and problem-solving skills
- Ability to work independently with strong attention to detail
- Ability to multitask and prioritize with minimal supervision
- Experience with AI tools and technologies is highly desired
Benefits and perks
- Medical, dental, and vision coverage for employees and eligible family members, including mental health benefits
- Annual employer contribution to a health savings account
- Generous paid time off, plus 10 company-paid holidays
- Market-leading retirement plan with company match and potential discretionary contribution
- Up to 12 weeks of paid parental leave
- Award-winning wellness programs
- Employee Assistance Fund
- Commute and parking benefits
- Work-from-home flexibility for most roles
- Bonus opportunity
Location
Idaho, US
Employment Type
Full-time
Experience Level
Intermediate Level
Salary Range
$76,500 - $103,500
Remote work allowed
Yes
Posted
1 month ago