Payment Integrity Subject Matter Expert - Inpatient/Outpatient

EXL Talent Acquisition Team; United States; Sur place; USD 103 000 - 138 000; Temps partiel

Résumé du poste

EXL Service seeks experienced Inpatient and Outpatient Payment Integrity SMEs to identify overpayment opportunities, develop new audit concepts, and enhance analytics. This part-time, temporary role requires up to 20 hours per week and is project-based for 4–6 months, with a base pay range of $75.00–$100.00/hr.

The SME will collaborate with analytics, clinical, coding, operations, and technology teams to translate billing expertise into scalable audit concepts, rules, and automated selection

Qualifications

• Deep knowledge of healthcare claims, coding, reimbursement, audit outcomes, and billing patterns across inpatient and outpatient settings.

Responsabilités

• Collaborate with analytics, clinical, coding, operations, and technology teams to translate healthcare billing expertise into scalable audit concepts, business rules, and automated selection strategies.
• Develop and refine audit concepts, concepts and rules to identify overpayments and improve payment integrity analytics.
• Translate claim-level insights into actionable audit concepts and selection strategies for faster, more accurate results.

Connaissances

Healthcare claims

Billing patterns

Audit concepts

Cross-functional collaboration

Description du poste

We are seeking experienced Inpatient and Outpatient Payment Integrity Subject Matter Experts (SMEs) to support the identification of overpayment opportunities, development of new audit concepts, enhancement of existing concepts, and improvement of payment integrity analytics. This role requires deep knowledge of healthcare claims, coding, reimbursement, audit outcomes, and billing patterns across inpatient and outpatient settings.

The SME will collaborate closely with analytics, clinical, coding, operations, and technology teams to translate healthcare billing expertise and claim-level insights into scalable, high-performing audit concepts, business rules, and automated selection strategies.

This is a part-time, temporary position requiring up to 20 hours per week. Work hours may vary based on project needs, audit concept development priorities, and collaboration requirements with analytics and operational teams. Project is expected to last 4-6 months.

*Base Pay Range: $75.00 - $100.00/hr

For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits