As a Payment Integrity Specialist, you will play a crucial role in automating medical claim audits. You will review claim forms, patient medical records, and audit results to train their AI-driven platform. The primary responsibilities include identifying coding/billing violations, auditing revenue codes against clinical documentation, and ensuring accuracy in claims billed versus health plan payments.
This Role Offers:
· 100% Employer Paid Medical, Dental, and Vision benefits
· Flexible, paid vacation policy
· Work in a flat organizational structure with direct access to leadership.
Focus:
· Review UB-04/IB forms for coding/billing violations.
· Audit revenue codes against clinical documentation.
· Confirm services billed were rendered.
· Document inconsistencies in claims versus health plan payments.
· Validate automatic audit results based on national and payer-specific guidelines.
Skill Set:
· Facility inpatient coding/auditing experience is required.
· Extensive experience in medical billing, coding, or auditing of insurance claims and medical records.
· Familiarity with national coding guidelines such as CPT codes, ICD-9/10, HCPCS codes, DRGs, APCs, etc.
· Knowledge of hospital-based billing/coding and PHI/HIPAA compliance
· At least three years of experience in auditing and reviewing medical bills.
· One of the following certifications is mandatory: CPC/COC/CIC/CRC/CPMA
· Clinical license required (RN preferred)
· Experience working at an insurance company is preferred.
Job Type: Full-time
Pay: $80,000.00 - $90,000.00 per year

Benefits:

• Dental insurance
• Health insurance
• Vision insurance

Work Location: Remot

Please refer the Job description for details