Payment Integrity Subject Matter Expert - Inpatient/Outpatient

EXL; United States; On-site; USD 103,000 - 138,000; Part time

Job summary

United States Digital Space LLC seeks experienced Inpatient and Outpatient Payment Integrity SMEs to identify overpayment opportunities, develop new audit concepts, and enhance analytics across inpatient and outpatient claims.

This part-time, temporary role requires up to 20 hours per week, with the project expected to last 4–6 months. Collaboration with analytics, clinical, coding, operations, and technology teams is essential to translate billing expertise into scalable, automated audit rules.

Qualifications

• Experience identifying overpayment opportunities in healthcare claims.
• Experience developing audit concepts and business rules.

Responsibilities

• Collaborate with analytics, clinical, coding, operations and technology teams to translate healthcare billing expertise into scalable audit concepts and automated selection strategies.
• Translate claim-level insights into high‑performing audit concepts and business rules.

Skills

Healthcare claims

Medical coding

Reimbursement rules

Audit outcomes

Billing patterns

Job description

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