Remote Payment Integrity Analyst II — Clinical Audits

CorVel; United States; Remote; USD 67,000 - 101,000; Full time

Benefits offered by this job

Medical (HDHP) w/Pharmacy

Dental

Vision

Long Term Disability

Health Savings Account

Flexible Spending Account Options

Life Insurance

Parking and Transit FSA accounts

401K

ROTH 401K

Paid time off

Job summary

CorVel is seeking a Payment Integrity Analyst to conduct pre- and post-pay claim audits in accordance with client policies and CMS guidelines. This remote role emphasizes clinical judgment, accuracy, and adherence to payer standards across multiple audit types, including DRG and itemized bill reviews.

A current LPN/LVN/RN license and healthcare revenue cycle experience are required. Ideal candidates will excel in Excel Pivot tables, data analysis, and clear written communication, with

Qualifications

• Must maintain a current LPN, LVN and/or RN licensure.
• 1+ years healthcare revenue cycle experience.
• Experience in medical bill auditing.
• Experience in hospital bill auditing.

Responsibilities

• 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.
• Use clinical judgement to interpret and apply client policies along with CMS guidelines as it relates to CERIS reviews 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, company meetings, trainings, and other meetings.
• Additional duties as assigned.

Skills

Clinical judgment

CMS policies

Revenue cycle

Pivot tables

Written communication

Interpersonal skills

Multitasking

Data analysis

Education

LPN/LVN/RN licensure

Bachelor's degree in healthcare

Tools

Microsoft Office

Pivot tables in Excel

Database tools

Job description

CorVel is seeking a Payment Integrity Analyst to conduct pre- and post-pay claim audits in accordance with client policies and CMS guidelines. This remote role emphasizes clinical judgment, accuracy, and adherence to payer standards across multiple audit types, including DRG and itemized bill reviews.

A current LPN/LVN/RN license and healthcare revenue cycle experience are required. Ideal candidates will excel in Excel Pivot tables, data analysis, and clear written communication, with