Note: The job is a remote job and is open to candidates in USA. CorVel Corporation is a certified Great Place to Work® Company that focuses on healthcare payment accuracy and transparency. The Payment Integrity Analyst II is responsible for reviewing and completing claim audits in accordance with client policies and CMS guidelines, utilizing clinical judgment and analytical skills for effective audit performance.
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
- 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
Skills
- Ability to use clinical judgment and analytical skills for claim audit review
- Knowledge of CMS/commercial payer policies, claims processing and reimbursements, IDC-10 Coding, and DRG Validation
- Familiarity with healthcare revenue cycle and coordination of benefits
- Proficiency in Microsoft Office, especially using pivot tables in Excel as well as and database tools
- Excellent written and verbal communication skills
- Strong interpersonal skills across all levels; comfortable interfacing with clients and the C-Suite
- Ability to work on several concurrent tasks and prioritize workload to meet designated deadlines
- Advanced problem-solving and data analysis capabilities
- Proven track record of delivering actionable results
- Strong attention to detail
- Must maintain a current LPN, LVN and/or RN licensure
- Previous experience in one or more of the following areas required: Medical bill auditing, Experience in the acute clinical areas of facilities in O.R., I.C.U., C.C.U., E.R., Telemetry, Medical/Surgical, OB or L&D, Geriatrics and Orthopedics, Knowledge of worker's compensation claims process, Prospective, concurrent and retrospective utilization review
- 1+ years healthcare revenue cycle
- 1+ years of relevant experience or equivalent combination of education and work experience
- 1+ years hospital bill audit
- Bachelor's degree in healthcare or related field preferred
- Preferred experience with health insurance denials and/or appeals, payer audits, or vendor audits
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
Company Overview
CorVel is a nationally recognized claims management and managed care provider with over 30 years of experience in the industry. It was founded in 1987, and is headquartered in Irvine, California, USA, with a workforce of 1001-5000 employees. Its website is https://www.corvel.com/.