Payment Integrity Professional 2

Job Title: Payment Integrity Professional 2 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