Professional, Overpayment Recovery and Monitoring ...

Join Us in Shaping the Future of Health Care At MVP Health Care, weu2019re on a mission to create a healthier future for everyone. That means embracing innovation, championing equity, and continuously improving how we serve our communities. Our team is powered by people who are curious, humble, and committed to making a differenceu2014every interaction, every day. Weu2019ve been putting people first for over 40 years, offering high-quality health plans across New York and Vermont and partnering with forward-thinking organizations to deliver more personalized, equitable, and accessible care. As a not-for-profit, we invest in what matters most: our customers, our communities, and our team. Whatu2019s in it for you: + Growth opportunities to uplevel your career + A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team + Competitive compensation and comprehensive benefits focused on well-being + An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work For in the NY Capital District , one of the Best Companies to Work For in New York , and an Inclusive Workplace . Youu2019ll contribute to our humble pursuit of excellence by bringing curiosity to spark innovation, humility to collaborate as a team, and a deep commitment to being the difference for our customers. Your role will reflect our shared goal of enhancing health care delivery and building healthier, more vibrant communities. Qualifications youu2019ll bring: + Bacheloru2019s degree in Health Administration, Business, Economics, Health Informatics, or related field. Associateu2019s degree with the equivalent combination of related experience may also be considered. + Coding certification, such as AAPC CPC, CIC, COC, CCS is required. + The availability to work full-time, virtual in New York State + A minimum of three (3) yearsu2019 experience in a professional coding environment and three (3) yearsu2019 experience in auditing and/or reviewing in relevant healthcare industry experience. + Intermediate knowledge of provider reimbursement methodologies and all current coding methodologies. + Intermediate knowledge of Health Insurance and various plan types. Intermediate analytical, problem-solving skills and attention to details. + Ability to initiate education with providers and make internal recommendations for process improvements. Goals and outcomes of the recommendations and education must be measurable. + Curiosity to foster innovation and pave the way for growth + Humility to play as a team + Commitment to being the difference for our customers in every interaction Your key responsibilities: + Manage recurring audit inventories, ensuring timely progression and completion of existing audits. + Identify and initiate new audits as patterns emerge through risk-based monitoring efforts, datamining, and other routine payment policy reviews. + Analyze new opportunities to substantiate, size, and prioritize audit needs, and develop audit protocols for new audit types. + Report suspected fraud and abuse to the SIU for further investigation and identify providers in need of education. + Collect and validate Key Performance Indicators (KPIu2019s) from payment integrity functions across the organization. + Assist in the reporting of monthly metrics and participate in cross-functional audit operations. + Handle department projects, participate in committees relevant to payment integrity, and support process improvement efforts. + Participate in training and development activities within the department and corporation. + Perform other audit activities and manual reviews as requested, ensuring accuracy of claims and supporting overall payment accuracy. + Perform research using u201cbest practicesu201d in auditing methodologies, remaining current in CPC coding, reimbursement methodologies, MVP Policies and Procedures, and updates in professional literature. + Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer. Where youu2019ll be: Virtual within New York State Pay Transparency MVP Health Care is committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role. We do not request current or historical salary information from candidates. $69,383.00-$92,279.00 MVP's Inclusion Statement At MVP Health Care, we believe creating healthier communities begins with nurturing a healthy workplace. As an organization, we strive to create space for individuals from diverse backgrounds and all walks of life to have a voice and thrive. Our shared curiosity and connectedness make us stronger, and our unique perspectives are catalysts for creativity and collaboration. MVP is an equal opportunity employer and recruits, employs, trains, compensates, and promotes without discrimination based on race, color, creed, national origin, citizenship, ethnicity, ancestry, sex, gender identity, gender expression, religion, age, marital status, personal appearance, sexual orientation, family responsibilities, familial status, physical or mental disability, handicapping condition, medical condition, pregnancy status, predisposing genetic characteristics or information, domestic violence victim status, political affiliation, military or veteran status, Vietnam-era or special disabled Veteran or other legally protected classifications. To support a safe, drug-free workplace, pre-employment criminal background checks and drug testing are part of our hiring process. If you require accommodations during the application process due to a disability, please contact our Talent team at .

Created: 2026-01-05