Payment Integrity Specialist
$60,000–$90,000 year
Remote · Springfield, Massachusetts, United States or United States
Springfield, Massachusetts, United States or United StatesRemoteFull Time$60,000–$90,000 yearMid LevelBachelors DegreeUnknown
Type
Full Time
Level
Mid Level
Education
Bachelors Degree
Company size
Unknown
Job Summary
The Payment Integrity Specialist will manage audit functions, investigate fraud, waste, and abuse activities, and ensure compliance with healthcare regulations, requiring a Bachelor's degree and over 3 years of relevant experience.
Required Qualifications
- Bachelor's degree in Business, Healthcare Administration or related field
- More than 3 years claims auditing experience
- Experience in Medicare compliance
- Experience in Fraud, Waste & Abuse preferably in an HMO or MCO
Desired Qualifications
- CPC and/or CPC-H certification preferred
- CPMA certification preferred
- Proficiency with healthcare coding (CPT/HCPCS, ICD-9 and ICD-10 & Revenue Codes)
- Highly effective research, writing, and communication skills
- Skilled with Microsoft Office Suite (Access, Word, Excel, PowerPoint)
- Good problem-solving skills
- Excellent organizational skill
- Strong attention to detail
- Excellent critical thinking, and analysis skills
- Ability to understand and interpret government health insurance laws and regulations
- Ability to present an unpopular opinion
- Ability to work well independently or with others
- Ability to work well with both internal and external customers
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