Associate, Payment Integrity

📋 Description

• Provide subject-matter expertise on Payment Integrity edits and reimbursement policies.
• Identify payment issues from data mining and monitoring; define remediation steps.
• Respond to inquiries and disputes about policies and edits.
• Document coding rules and recommend reimbursement policy language.
• Ideate PI opportunities and translate into business requirements with partners.
• Provide training and keep stakeholders informed; support escalation when needed.

🎯 Requirements

• Bachelor’s degree or 4+ years of commensurate experience.
• 4+ years in claims processing, coding, auditing, or healthcare ops.
• 4+ years experience in medical coding.
• Medical coding certification (AAPC or AHIMA).
• Experience with reimbursement methodologies and provider contracts.
• 3+ years ability to work independently to drive projects to completion.

Bonus points

• 3+ years in a technical or process-improvement role.
• 3+ years working with large data sets (Excel or database language).
• Experience in a healthcare claims organization.
• Knowledge management or training in operational settings.
• Lean Six Sigma training.
• Experience using SQL.