Remote Lead, Payment Integrity Analyst

CorVel Corporation; Fort Worth (TX); On-site; USD 73,345 - 113,247; Full time

Job summary

CorVel Corporation seeks a Payment Integrity Analyst (Team Lead) to supervise the Policy and Payment Integrity (PPI) team while overseeing audits per client policy and CMS guidelines.

The role emphasizes leadership, staff training, and timely completion of audits, with a remote work arrangement. Strong knowledge of CMS policies, ICD-10 coding, and DRG validation is required to ensure accuracy and compliant payments.

Qualifications

• Must maintain current LPN/LVN/RN licensure (RN hires only).
• Experience with health insurance denials or appeals preferred.
• Experience in medical bill auditing and payer audits.
• Knowledge of workers’ compensation claims process and utilization review.

Responsibilities

• Review pre- and post‑payment audits per client policy and CMS guidelines.
• Lead the PPI team, oversee staff, set goals, and provide training.
• Verify and correct audits completed by PPI QC analysts.
• Review, analyze, and complete internal audits and/or appeals per CMS guidelines.
• Apply clinical judgment to documentation submitted for claim audits.
• Attend team and company meetings and other trainings.
• Complete internal audits and/or appeals in a timely manner.

Skills

CMS policy knowledge

Claims processing

ICD-10 coding

DRG validation

Revenue cycle

Data analysis

Communication skills

Team leadership

Education

RN license

Bachelor’s degree preferred

3+ years healthcare revenue cycle experience

Tools

Microsoft Office

Pivot tables

Database management

Job description

CorVel Corporation seeks a Payment Integrity Analyst (Team Lead) to supervise the Policy and Payment Integrity (PPI) team while overseeing audits per client policy and CMS guidelines.

The role emphasizes leadership, staff training, and timely completion of audits, with a remote work arrangement. Strong knowledge of CMS policies, ICD-10 coding, and DRG validation is required to ensure accuracy and compliant payments.