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CERIS · 1 month ago

Payment Integrity Analyst II - DRG Auditor

United States

Full-time

Remote

Entry, Mid Level

$65K/yr - $99K/yr

1+ years exp

CERIS, a division of CorVel Corporation, is committed to accuracy and transparency in healthcare payments. The Payment Integrity Analyst is responsible for reviewing claim audits based on client and industry standards, ensuring compliance with CMS guidelines.

Health CareMedicalPayments

Responsibilities

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

Ability to use clinical judgement and analytical skills to appropriately review documentation submitted for claim audits

Utilize 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, All Company Meetings, Education Opportunities, Trainings, and other potential meetings

Additional duties as assigned

Qualification

ICD-10 CodingDRG ValidationHealthcare revenue cycleClaims processingMicrosoft OfficeAnalytical skillsClient interfacingHealthcare auditsUtilization reviewCommunication skillsInterpersonal skillsProblem solvingAttention to detailProject management

Required

Must maintain a current LPN, LVN and/or RN licensure

1+ years healthcare revenue cycle

1+ years of relevant experience or equivalent combination of education and work experience

1+ years hospital bill audit

Ability to demonstrate understanding of CMS and commercial payer policy in written and verbal format

Strong understanding of claims processing, ICD-10 Coding, DRG Validation, Coordination of Benefits

Strong understanding of healthcare revenue cycle and claims reimbursement

Proficient in Microsoft Office including Pivot Tables and Database Management

Comfortable interfacing with clients and the C-Suite

Demonstrate ability to manage multiple projects, set priorities and adhere to committed schedule

Strong interpersonal skills and adaptive communication style, complex problem solving skills, drive for results, innovative

Excellent written and verbal communication skills

Proven track record of delivering concrete results in strategic projects/programs

Strong analytical and modeling ability and distilling data into actionable results