Payment Integrity Analyst

Our client is a high-growth, venture-backed startup, dedicated to revolutionizing the U.S. healthcare system. They encourage collaboration among individuals with diverse backgrounds and ideologies to drive innovation. If you're passionate about leveraging cutting-edge technologies to make a significant impact on U.S. healthcare, we invite you to join this company’s mission-driven team.As a Payment Integrity Analyst, you will play a crucial role in automating medical claim audits. You will review claim forms, patient medical records, and audit results to train their platform. The primary responsibilities include identifying coding/billing violations, auditing revenue codes against clinical documentation, and ensuring accuracy in claims billed versus health plan payments.This Role Offers:Medical, Dental, and Vision benefitsFlexible, paid vacation policyWork in a flat organizational structure with direct access to leadership.Focus:Review UB-04/IB forms for coding/billing violations.Audit revenue codes against clinical documentation.Confirm services billed were rendered.Document inconsistencies in claims versus health plan payments.Validate automatic audit results based on national and payer-specific guidelines.Skill Set:Facility inpatient coding/auditing experience is required.Extensive experience in medical billing, coding, or auditing of insurance claims and medical records.Familiarity with national coding guidelines such as CPT codes, ICD-9/10, HCPCS codes, DRGs, APCs, etc.Knowledge of hospital-based billing/coding and PHI/HIPAA complianceAt least three years of experience in auditing and reviewing medical bills.One of the following certifications is mandatory: CPC/COC/CIC/CRC/CPMAClinical license preferred (RN)Experience working at an insurance company is preferred.100% remote work considered for the right candidateAbout Blue Signal: Blue Signal is a leading executive search firm specializing in healthcare recruiting. Our healthcare recruiters have expertise in placing high-performing talent in healthcare IT, medical devices, biotechnology, pharmaceuticals, etc. Learn more at /3G5DbWr

Created: 2025-06-03