Payment Integrity Clinician - Remote

About the Role

We are seeking a dedicated Payment Integrity Clinician - Remote to join our dynamic healthcare team. As a Payment Integrity Clinician, you will play a crucial role in ensuring the accuracy and compliance of medical claims processing. This position offers the flexibility of remote work while contributing to the integrity of healthcare payments.

What You'll Do

• Review and analyze medical claims to ensure adherence to regulatory compliance and coding standards.
• Collaborate with healthcare providers to resolve discrepancies and improve claims accuracy.
• Utilize data analysis techniques to identify trends and areas for improvement in claims processing.
• Participate in quality improvement initiatives aimed at enhancing the payment integrity process.
• Provide education and support to providers regarding coding and billing practices.

Requirements

• Minimum of 3 years of experience in healthcare claims review or related field.
• Strong knowledge of ICD 10-CM coding and HEDIS measures.
• Experience with regulatory compliance and quality management in healthcare.
• Excellent analytical skills and attention to detail.
• Ability to work independently in a remote environment.

Nice to Have

• Certification in medical coding (CPC, CCS, etc.)
• Experience with automated dispensing systems and workflow management.
• Familiarity with pharmacy operations and business strategy.

What We Offer

• Competitive salary range based on experience.
• Comprehensive health benefits including medical, dental, and vision.
• Opportunities for professional development and career advancement.
• Flexible working arrangements to promote work-life balance.
• Access to company resources and training programs.
• Employee wellness programs and initiatives supporting diversity and inclusion.