Payment Integrity Analyst III - QA Analyst

CorVel Corporation; Fort Worth, Northern (TX, KY); Hybrid; USD 75,000 - 110,000; Full time

Benefits offered by this job

Medical (HDHP) w/Pharmacy

Dental, Vision

401K & Roth 401K

Paid time off

Job summary

CorVel Corporation seeks a Payment Integrity Analyst III - QA Analyst to lead the PPI team and conduct audits per CMS guidelines and client policy. The role requires strong clinical judgment, attention to detail, and expertise in revenue cycle processes.

This remote position supports multiple clients with quality assurance responsibilities. The ideal candidate will have 3+ years in healthcare revenue cycle or payment integrity, experience with denials/appeals, and proficiency in data analysis

Qualifications

• Must maintain a current LPN/LVN and/or RN licensure (applies only to RN hires)
• Preferred experience with health insurance denials and/or appeals, payer audits, or vendor audits
• 3+ years healthcare revenue cycle or payment integrity experience
• Experience in medical bill auditing and acute clinical areas (OR, ICU, ER, etc.)
• Bachelor’s degree in healthcare or related field preferred

Responsibilities

• Lead staff with updates, issue resolution, goals and standards
• Oversee team quality and compliance, train staff
• Verify and correct audit work by PPI QC analysts
• Review audits and appeals per client policy and CMS guidelines
• Apply clinical judgement to review documentation
• Interpret and apply client policies with CMS guidelines
• Use tools to complete audits and appeals
• Ensure timely completion of audits and appeals
• Attend team and company meetings
• Handle additional duties as assigned

Skills

CMS policy comprehension

ICD-10 Coding

DRG Validation

Healthcare revenue cycle

Data analysis

Team leadership

Written/verbal communication

Project management

Education

Bachelor’s degree in healthcare or related field

3+ years healthcare revenue cycle or payment integrity experience

RN/LPN/LVN licensure for RN hires

Tools

Microsoft Office

Pivot Tables

Database Management

Job description

Payment Integrity Analyst III - QA Analyst

Job Category: CERIS

Requisition Number: PAYME011526

• Posted : July 6, 2026
• Full-Time

Locations

TX - Fort Worth
5128 Apache Plume Rd
Suite 400
Fort Worth, TX 76109, USA

The Payment Integrity Analyst (Team Lead) assists with leading the Policy and Payment Integrity (PPI) team while maintaining the regular duties and responsibilities of this role which is accurately reviewing pre and post pay claim audits based on client, policy, industry standards and/or CMS guidelines.

The Team Lead must also be knowledgeable of the application of client policy and industry standards within reviews conducted by CERIS including but not limited to itemized bill review, professional review, hospital outpatient; trend analysis of internal auditing, appeals of pre and post payment claims, and any other claim or record that requires quality review to determine claim accuracy; assist with development of internal quality assurance measures based on client policy and industry guidelines; perform quality assurance reviews; assist in researching and implementing best practices related to payment policy, and/or policy initiatives; researching various healthcare policies.

This is a remote position.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES

• Assists with staff communication, providing updates, resolving issues, setting goals and maintaining standards as well as dialogue with team members in efforts to answer their questions and resolve barriers
• Oversees team member work for quality and compliance and communicates deadlines and productivity goals to team members while providing ongoing training and education to staff to ensure policies and procedures are followed
• Verifies and corrects as necessary, the audit work completed by PPI QC analysts and clinical appeal review teams as needed
• Reviews, analyzes, and completes internal audits and/or appeals in accordance with client policy, CMS guidelines and industry standards in clear and professional written communication
• Ability to use clinical judgement and analytical skills to appropriately review documentation submitted for claim audits
• Utilize clinical judgement to appropriately interpret and apply client policies along with CMS guidelines as it relates to reviews done by CERIS such as itemized bill, DRG and/or specialty audits
• Utilize applicable tools and resources to complete internal audits and/or appeals
• Timely completion of internal audits and/or appeals
• Attends Clinical Team Meetings, All Company Meetings, Education Opportunities, Trainings, and other potential meetings
• Additional duties as assigned

KNOWLEDGE & SKILLS

• Ability to demonstrate understanding of CMS and commercial payer policy in written and verbal format
• Strong understanding of claims processing, ICD-10 Coding, DRG Validation, Coordination of Benefits
• Strong understanding of healthcare revenue cycle and claims reimbursement
• Proficient in Microsoft Office including Pivot Tables and Database Management
• Demonstrate ability to manage multiple projects, set priorities and adhere to committed schedule
• Strong interpersonal skills and adaptive communication style, complex problem-solving skills, drive for results, innovative
• Excellent written and verbal communication skills
• Proven track record of delivering concrete results in strategic projects/programs
• Strong analytical and modeling ability and distilling data into actionable results
• Superb attention to detail and ability to deliver results in a fast paced and dynamic environment

EDUCATION/EXPERIENCE

• Must maintain a current LPN, LVN and/or RN licensure (this applies only to RN hires, not coders)
• Preferred experience with health insurance denials and/or appeals, payer audits, or vendor audits
• Previous experience in one or more of the following areas required:
• Medical bill auditing
• Experience in the acute clinical areas of facilities in O.R., I.C.U., C.C.U., E.R., Telemetry, Medical/Surgical, OB or L&D, Geriatrics and Orthopedics
• Knowledge of worker's compensation claims process
• Prospective, concurrent and retrospective utilization review
• Bachelor’s degree in healthcare or related field preferred
• 3+ years healthcare revenue cycle or payment integrity experience
• 3+ years of relevant experience or equivalent combination of education and work experience

PAY RANGE

CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.

In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.

Benefits

A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/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, 401K, ROTH 401K, and paid time off.

Equal Opportunity Employer

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable. This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.