Payment Integrity Analyst II

Job Details

Description

The Policy and Payment Integrity Analyst II assists with the development, implementation, and maintenance of an effective compliance policy and payment integrity program for our multi-state healthcare organization. This individual is responsible for researching and identifying best practices in the development and implementation of payment policy, and/or policy initiatives; researching various healthcare policies; interpreting client, state, and CMS payment policies; assist in writing white papers and other documents that are used to assist in the review of claims for hospital bill audits.

Essential Functions & Responsibilities

• Research and assist in executing and developing programs addressing healthcare payer policy changes and/or other topics identified as potential risk areas
• Maintain an awareness of current laws, statutes, regulations, etc. that impact healthcare operations, and design strategies and solutions to address
• Research, interpret and apply CMS, Federal, State and client policies to claims review
• Verbally communicate interpretation of CMS, Federal, State and client policies to providers
• Coordinate compliance policy development and/or revision as needed
• Gather appropriate compliance controls are in place as required by state and federal laws
• Track current and pending legislation and program changes while coordinating communication and implementation activities within the organization
• Demonstrate ability to manage multiple projects, set priorities and manage to committed schedule
• Consolidate all program and industry related documentation in company SharePoint site
• Build external alliances with customers and industry experts to gain and share information and industry trends
• Act as a resource for leadership and Account Management
• Performs provider contract review based on business needs
• Assists organization in obtaining complex information from various financial, clinical and operational systems and data sources related to policy review
• Assists with evaluation of client data related to policy review and/or implementation including actively participating with and supporting the Product and Account Management teams with trend analysis
• Additional duties as assigned
  
  

Knowledge & Skills

• 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 Benefit
• 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 manage 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
  
  

Education & Experience

• Must maintain a current 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
• Bachelor’s degree in healthcare or related field
• 5 years healthcare revenue cycle
• 5 years of relevant experience or equivalent combination of education and work experience
• 3 years hospital bill audit
• 1 year project management
  
  

Pay Range

CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.

Pay Range: $68,566 – $104,841

A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management

In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.

About CERiS

CERiS, a division of CorVel Corporation, a certified Great Place to Work® Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in healthcare payments. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities. We embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

A comprehensive benefits package is available for full-time regular employees and includes 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, and paid time off.

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.