State Licensed Payment Integrity Specialist

A company is looking for a Senior Specialist, Payment Integrity. Key Responsibilities Serve as a subject matter expert on reimbursement policies and payment integrity processes Investigate and resolve provider disputes related to claims and payments Collaborate with internal and external partners to identify and implement payment integrity improvements Required Qualifications Bachelor's degree or 4+ years of relevant experience 4+ years of experience in claims processing, coding, auditing, or healthcare operations 3+ years of experience in medical coding with relevant certification Experience with reimbursement methodologies and claims processing practices 2+ years of experience deriving business insights from datasets

Mar 21, 2025 - 20:15

A company is looking for a Senior Specialist, Payment Integrity. Key Responsibilities Serve as a subject matter expert on reimbursement policies and payment integrity processes Investigate and resolve provider disputes related to claims and payments Collaborate with internal and external partners to identify and implement payment integrity improvements Required Qualifications Bachelor's degree or 4+ years of relevant experience 4+ years of experience in claims processing, coding, auditing, or healthcare operations 3+ years of experience in medical coding with relevant certification Experience with reimbursement methodologies and claims processing practices 2+ years of experience deriving business insights from datasets