Do you have a deep understanding of payment integrity concepts, strong organizational skills, and the ability to identify and validate medical insurance claim overpayments through data mining efforts??
You may be ideal for this position if:
- Minimum 2 years of experience in health insurance payment integrity
- Knowledge of claim coding, including CPT, HCPCS, ICD-10 codes, and modifiers.
- Knowledge of claim reimbursement methodologies such as: DRG, OPPS, APC, NCCI Edits, MUE’s, and determining patient liability amounts.
- Demonstrated ability to learn and navigate multiple payer systems and applications.
- Intermediate Excel skills
More about the position
- Validating claim overpayments based on reimbursement methodology, claim coding details, and the audit’s edit parameters
- Compiling sample claims and supporting documentation for Client review and approval
- Maintaining a library that includes instructions for validating specific audit concepts
- Assisting in review of provider appeals
- Identify process and audit concept improvements to ensure the best outcomes
Why choose ClarisHealth?
- ClarisHealth unites data and people through innovative technology.
- Remote-first flexible working environment
- OUR AMAZING BENEFITS
- Health insurance, including $0 premium HDHP and $0 deductible PPO options. FIRST-DAY COVERAGE!
- Generous Paid Time Off: 4 weeks PTO, 1 week Wellness Time, 2 days volunteer time off, 9 holidays, 2 floating holidays
- 401(k) with matching, immediate vesting
- “Got Your Back” environment
- We work hard, but we know how to take time and enjoy life
