Remote Payment Integrity Team Lead

CorVel Corporation; Fort Worth (TX); Hybrid; USD 70,000 - 100,000; Full time

Job summary

CorVel Corporation is seeking a Payment Integrity Analyst (Team Lead) to guide the Policy and Payment Integrity (PPI) team while delivering core audit responsibilities. You will review pre- and post-pay claims using client policies, CMS guidelines, and industry standards, with emphasis on itemized bill review, DRG validations, and appeals.

The role requires strong analytical abilities, clinical judgement, and proficiency in healthcare revenue cycle processes, with the ability to lead a remote

Qualifications

• Must maintain a current LPN, LVN and/or RN licensure (RN hires only).
• Preferred experience with health insurance denials or appeals, payer audits, or vendor audits.
• Experience in medical bill auditing and acute clinical care areas (OR, ICU, CCU, ER, etc.).
• Knowledge of worker’s compensation claims process and utilization review.

Responsibilities

• Assist with staff communication, updates, issue resolution, and goal setting.
• Oversee team quality, provide training to ensure policy compliance.
• Verify and correct audit work by PPI QC analysts and appeals teams.
• Review and complete internal audits and appeals per CMS guidelines and policy.
• Use clinical judgement to review documentation for claim audits.
• Interpret and apply client policies and CMS guidelines in CERIS reviews.
• Utilize tools to complete audits and appeals in a timely manner.
• Attend meetings and participate in ongoing education and trainings.
• Perform additional duties as assigned.

Skills

CMS knowledge

ICD-10/DRG

Revenue cycle

Microsoft Excel

Pivot Tables

Database management

Project management

Communication

Analytical skills

Attention to detail

Education

RN/LPN/LVN licensure

Bachelor’s degree in healthcare or related field

3+ years healthcare revenue cycle experience

3+ years relevant experience or equivalent combination

Tools

Microsoft Excel

Pivot Tables

Database Management

Job description

CorVel Corporation is seeking a Payment Integrity Analyst (Team Lead) to guide the Policy and Payment Integrity (PPI) team while delivering core audit responsibilities. You will review pre- and post-pay claims using client policies, CMS guidelines, and industry standards, with emphasis on itemized bill review, DRG validations, and appeals.

The role requires strong analytical abilities, clinical judgement, and proficiency in healthcare revenue cycle processes, with the ability to lead a remote