Auditor, Payment Integrity (Chart Review - Remote) jobs in United States
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Independence Blue Cross · 1 month ago

Auditor, Payment Integrity (Chart Review - Remote)

positionUnited States
timeFull-time
remoteRemote
seniorityMid Level

Independence Blue Cross is focused on enhancing the health and well-being of the communities they serve. They are seeking a meticulous and analytical Payment Integrity Auditor to ensure accurate claims payment and uphold compliance with regulatory standards through detailed chart reviews.

Health CareHealth InsuranceInsuranceMedical

Responsibilities

Perform medical chart reviews to ensure provider billing adherence to medical policies and claims payment policies
Review inpatient charts to validate DRG assignment based on ICD-10-CM and ICD-10-PCS coding
Ensure compliance with CMS guidelines, payer policies, and official coding rules
Perform Readmission audits to identify related admissions per claims payment policy criteria
Provide detailed clinical and coding rationale to support audit findings
Collaborate with Providers and Medical Directors to resolve audit disputes
Initiate, verify, and reconcile claim adjustments. Maintain audit documentation
Perform other duties of the Payment Integrity Auditor as required

Qualification

CPCICD-10-CM codingInpatient Medical Chart ReviewAnalytical skillsMS OfficeMedical terminologyRegulatory requirements knowledgeCommunication skillsProblem-solving skills

Required

Strong knowledge of medical terminology and ICD-10-CM/PCS coding guidelines
Understanding of Inpatient Prospective Payment System (IPPS), MSDRG, and regulatory requirements and/or Outpatient Prospective Payment System (OPPS)
Inpatient Medical Chart Review experience
Analytical and detail-oriented with strong problem-solving skills
Excellent communication skills: verbal and written
Intermediate knowledge of MS Office: Excel, Word, Outlook
Must have an Android or iOS device that is compatible with the free Microsoft Authenticator app

Preferred

Bachelor's degree in a health care-related field or business-related discipline
Current credentials of CPC, RN, or RHIT/RHIA/CCS

Company

Independence Blue Cross

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The leading health insurer in southeastern Pennsylvania. It is a sub-organization of Independence Blue Cross.
dateFounded in 1938
location
Philadelphia, Pennsylvania, USA
people-size5001-10000 employees
web-link
https://www.ibx.com

Funding

Current Stage
Late Stage

Leadership Team

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Alexandra Jorgensen
Senior Vice President Human Resources
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Joe Geist
SVP & Market President, National
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Recent News

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Company data provided by crunchbase