Healthcare Payment Integrity Specialist

Health One Alliance, LLC; Dalton (GA); On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

401K (4% Match, Immediate Vesting)

Medical Insurance

Paid Time Off

Dental Insurance

Vision Insurance

Life & AD&D Insurance

Short Term Disability

Long Term Disability

Accident insurance

Flexible Spending Account

Health & Wellness Program

Health Savings Account

Critical Illness Insurance

Employee Assistance Program

Pet Insurance

Job summary

Health One Alliance, LLC is seeking a Payment Integrity Analyst in Dalton, GA. The role involves reviewing healthcare claims to detect errors or fraud while ensuring compliance with CMS regulations.

Key responsibilities include auditing claims, analyzing data trends, collaborating with internal teams, and preparing reports. Candidates should have experience in claims processing and medical billing, as well as strong analytical skills and knowledge of medical coding.

The position offers competitive benefits including health insurance, paid time off, and a 401K plan.

Qualifications

• Minimum of three years experience in claims processing is required, including Professional and Institutional processing.
• Knowledge of ICD-10, CPT4, DRG, and HCPCS codes preferred.
• Experience in medical billing and coding required if no claims processing experience.

Responsibilities

• Review and audit healthcare claims to identify payment errors and fraud.
• Ensure compliance with regulations and health plan policies.
• Analyze medical records and claims data to validate accuracy.

Skills

Data analysis

Medical coding (CPT/ICD-10)

Auditing skills

Claims processing

SQL reporting

Education

High School Diploma or GED

Associates or Bachelor's degree

Tools

Microsoft Word

Microsoft Excel

Job description

Health One Alliance, LLC is seeking a Payment Integrity Analyst in Dalton, GA. The role involves reviewing healthcare claims to detect errors or fraud while ensuring compliance with CMS regulations.

Key responsibilities include auditing claims, analyzing data trends, collaborating with internal teams, and preparing reports. Candidates should have experience in claims processing and medical billing, as well as strong analytical skills and knowledge of medical coding.

The position offers competitive benefits including health insurance, paid time off, and a 401K plan.