Remote Payment Integrity Team Lead - QA & Claims

CorVel Corporation; Fort Worth, Northern (TX, KY); Hybrid; USD 75,000 - 110,000; Full time

Benefits offered by this job

Medical (HDHP) w/Pharmacy

Dental, Vision

401K & Roth 401K

Paid time off

Job summary

CorVel Corporation seeks a Payment Integrity Analyst III - QA Analyst to lead the PPI team and conduct audits per CMS guidelines and client policy. The role requires strong clinical judgment, attention to detail, and expertise in revenue cycle processes.

This remote position supports multiple clients with quality assurance responsibilities. The ideal candidate will have 3+ years in healthcare revenue cycle or payment integrity, experience with denials/appeals, and proficiency in data analysis

Qualifications

• Must maintain a current LPN/LVN and/or RN licensure (applies only to RN hires)
• Preferred experience with health insurance denials and/or appeals, payer audits, or vendor audits
• 3+ years healthcare revenue cycle or payment integrity experience
• Experience in medical bill auditing and acute clinical areas (OR, ICU, ER, etc.)
• Bachelor’s degree in healthcare or related field preferred

Responsibilities

• Lead staff with updates, issue resolution, goals and standards
• Oversee team quality and compliance, train staff
• Verify and correct audit work by PPI QC analysts
• Review audits and appeals per client policy and CMS guidelines
• Apply clinical judgement to review documentation
• Interpret and apply client policies with CMS guidelines
• Use tools to complete audits and appeals
• Ensure timely completion of audits and appeals
• Attend team and company meetings
• Handle additional duties as assigned

Skills

CMS policy comprehension

ICD-10 Coding

DRG Validation

Healthcare revenue cycle

Data analysis

Team leadership

Written/verbal communication

Project management

Education

Bachelor’s degree in healthcare or related field

3+ years healthcare revenue cycle or payment integrity experience

RN/LPN/LVN licensure for RN hires

Tools

Microsoft Office

Pivot Tables

Database Management

Job description

CorVel Corporation seeks a Payment Integrity Analyst III - QA Analyst to lead the PPI team and conduct audits per CMS guidelines and client policy. The role requires strong clinical judgment, attention to detail, and expertise in revenue cycle processes.

This remote position supports multiple clients with quality assurance responsibilities. The ideal candidate will have 3+ years in healthcare revenue cycle or payment integrity, experience with denials/appeals, and proficiency in data analysis