Remote Payment Integrity Analyst II

CorVel Corporation; Fort Worth (TX); Remote; USD 60,000 - 90,000; Full time

Job summary

CorVel Corporation is seeking a Payment Integrity Analyst to review pre and post pay claim audits, applying CMS guidelines and client policies. This is a remote position with responsibilities spanning audits, documentation review, and coordination with clinical teams.

The role requires licensure (LPN/LVN or RN) and a background in healthcare revenue cycle, with preference for experience in denials/appeals. Strong communication and analytical skills are essential for success.

Qualifications

• Must maintain a current LPN, LVN and/or RN licensure.
• Preferred experience with health insurance denials and/or appeals, payer audits, or vendor audits.
• 1+ years healthcare revenue cycle experience.
• Experience in hospital bill auditing or related clinical settings.

Responsibilities

• Review, analyze, and complete internal audits and/or appeals per policy and CMS guidelines.
• Apply clinical judgement to documentation submitted for claim audits.
• Interpret client policies and CMS guidelines for CERIS reviews (e.g., DRG, itemized bill).
• Use tools to complete internal audits and ensure timely completion.
• Attend Clinical Team Meetings and trainings; perform additional duties as assigned.

Skills

CMS guidelines

Payer policy

Claims processing

ICD-10 Coding

DRG Validation

Healthcare revenue cycle

Microsoft Office

Data analysis

Education

LPN/LVN or RN licensure

Bachelor's degree in healthcare or related field (preferred)

Tools

Pivot Tables

Database Management

Job description

CorVel Corporation is seeking a Payment Integrity Analyst to review pre and post pay claim audits, applying CMS guidelines and client policies. This is a remote position with responsibilities spanning audits, documentation review, and coordination with clinical teams.

The role requires licensure (LPN/LVN or RN) and a background in healthcare revenue cycle, with preference for experience in denials/appeals. Strong communication and analytical skills are essential for success.