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Job Requirements of Payment Integrity Professional 2:
-
Employment Type:
Contractor
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Location:
Tampa, FL (Onsite)
Do you meet the requirements for this job?
Payment Integrity Professional 2
Careers Integrated Resources Inc
Tampa, FL (Onsite)
Contractor
Job Title: Payment Integrity Professional 2
Location: Remote (EST Shift)
Duration: 8+ Months (possible extension)
Job Description:
Required Qualifications:
Location: Remote (EST Shift)
Duration: 8+ Months (possible extension)
Job Description:
- The Payment Integrity Professional 2 contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment.
- Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
- Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
- The Payment Integrity Professional 2 plays a vital role in supporting investigations related to fraud, waste, abuse, and Special Investigations Unit (SIU) financial recovery.
- Responsibilities include assisting with the management, review, and reporting of SIU grievances, appeals, Independent Review Entity (IRE) overturns, Administrative Law Judge (ALJ) hearings, and STARs.
Required Qualifications:
- AAPC Coding Certification - CPC
- Minimum 2 years post certification experience utilizing coding guidelines by reading and interpreting claims, preferable with Medicare claims
- Exceptional understanding of Centres for Medicare & Medicaid Services (CMS) guidelines, correct coding initiatives, national benchmarks, and industry standards
- Experience using the following systems: CAS, CRM, MHK, Microsoft Word, Excel
- Experience reading and understanding medical claims
- Experience working with the Medicare Line of Business
- Experience Monitoring Compliance / Inventory
- Strong written communication skills, with an emphasis on clarity and grammar
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