Payment Integrity Analyst II

CorVel
Fort Worth, TX
Category Healthcare
Remote
Job Description
The Payment Integrity Analyst II is responsible for accurately reviewing and completing pre- and post-pay claim audits based on client, policy, industry standards and/or CMS guidelines.

Requirements

  • 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 appropriately interpret and apply client policies along with CMS guidelines as it relates to reviews done by CERIS 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, educational opportunities/trainings, and other meetings
  • Additional duties as assigned

Benefits

  • Medical (HDHP) w/Pharmacy
  • Dental
  • Vision
  • Long Term Disability
  • Health Savings Account
  • Flexible Spending Account Options
  • Life Insurance
  • Accident Insurance
  • Critical Illness Insurance
  • Pre-paid Legal Insurance
  • Parking and Transit FSA accounts
  • 401K
  • ROTH 401K
  • Paid Time Off
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