Payment Integrity Analyst

Blue Signal Search; Jacksonville (FL); Remote; USD 60,000 - 100,000; Full time

Job summary

An innovative and mission-driven startup is seeking a Payment Integrity Analyst to automate medical claim audits and ensure accuracy in healthcare billing. In this pivotal role, you will leverage your expertise in coding and auditing to validate claims and uphold compliance with national guidelines. Join a collaborative team that values diverse perspectives and is dedicated to transforming the U.S. healthcare system. This is a unique opportunity to make a significant impact while enjoying the flexibility of remote work options.

Benefits

Medical benefits

Dental benefits

Vision benefits

Flexible paid vacation policy

Direct access to leadership

Qualifications

• 3+ years of experience in auditing and reviewing medical bills.
• Knowledge of national coding guidelines and compliance.

Responsibilities

• Review claim forms for coding/billing violations.
• Audit revenue codes against clinical documentation.
• Document inconsistencies in claims versus health plan payments.

Skills

Facility inpatient coding/auditing experience

Medical billing and coding

Familiarity with CPT codes

Knowledge of PHI/HIPAA compliance

Experience in auditing medical bills

Certifications (CPC/COC/CIC/CRC/CPMA)

Education

Clinical license (RN)

Job description

3 weeks ago Be among the first 25 applicants

Direct message the job poster from Blue Signal Search

Director, Life Sciences & Medical Search | Talent Partner | Consultant | Executive Search

Our client is a high-growth, venture-backed startup, dedicated to revolutionizing the U.S. healthcare system. They encourage collaboration among individuals with diverse backgrounds and ideologies to drive innovation. If you're passionate about leveraging cutting-edge technologies to make a significant impact on U.S. healthcare, we invite you to join this company’s mission-driven team.

As a Payment Integrity Analyst, 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 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:

• 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 preferred (RN)
• Experience working at an insurance company is preferred.
• 100% remote work considered for the right candidate

About Blue Signal:

Blue Signal is a leading executive search firm specializing in healthcare recruiting. Our healthcare recruiters have expertise in placing high-performing talent in healthcare IT, medical devices, biotechnology, pharmaceuticals, etc. Learn more at bit.ly/3G5DbWr

Seniority level

• Mid-Senior level

Employment type

• Full-time

Job function

• Accounting/Auditing, Information Technology, and Health Care Provider

Industries

• Health and Human Services

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Inferred from the description for this job

Medical insurance

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