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 III - QA Analyst will lead the PPI team while conducting pre and post pay claim audits, ensuring compliance with client policies and industry standards.
Responsibilities
- Assists with staff communication, providing updates, resolving issues, setting goals and maintaining standards as well as dialogue with team members in efforts to answer their questions and resolve barriers
- Oversees team member work for quality and compliance and communicates deadlines and productivity goals to team members while providing ongoing training and education to staff to ensure policies and procedures are followed
- Verifies and corrects as necessary, the audit work completed by PPI QC analysts and clinical appeal review teams as needed
- 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
Skills
- Must maintain a current LPN, LVN and/or RN licensure (this applies only to RN hires, not coders)
- 3+ years healthcare revenue cycle or payment integrity experience
- 3+ years of relevant experience or equivalent combination of education and work experience
- 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
- 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
- Superb attention to detail and ability to deliver results in a fast paced and dynamic environment
- 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
- Preferred experience with health insurance denials and/or appeals, payer audits, or vendor audits
- Bachelor's degree in healthcare or related field preferred
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
Company H1B Sponsorship