Payment Integrity Consultant
Lyric - Clarity in motion.
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $122,425 - $183,638 per year
Job Level
Mid-LevelSenior
About the role
- Recommend new proposals for pre-payment claim edits to provide clients with incremental savings.
- Analyze paid claims data for the purpose of identifying overpayments and areas for incremental savings.
- Ability to provide detailed requirements to the development team to build proposals recommended by consultant.
- Function as a Consultant to internal and external clients to introduce new concepts, estimate realistic savings, and evangelize value to ensure client adoption.
- Stay abreast of all topics relevant to coding/billing/overpayment trends, changes in coding guidelines and industry standards.
- Prepare, deliver, and provide clinical support related to clinical content to both internal and external customers.
- Serve as clinical content SME on cross-functional teams, to communicate relevant client or industry feedback to project stakeholders for product revisions and/or new functionality.
Requirements
- Bachelor’s degree in healthcare information system management, Health Information Management, Nursing, or other Healthcare related degree preferred
- American Academy of Professional Coders (AAPC) Certified Professional Coders (CPC) certification or American Health Information Management Association (AHIMA) Certified Coding Specialist-Physician (CCS-P) is required prior to hire date.
- 5 years or more relevant healthcare experience as a medical coder, medical claims processor medical auditor, clinical editing analyst, or payment or medical policy analyst.
- Master’s degree in business or healthcare related field preferred.
- Previous experience in physician or centralized billing office with multi-specialty practices preferred.
- Previous experience as a nurse is a plus.
- Current working knowledge of pre-payment editing and payment integrity.
- Possess expertise at communication and presenting extraordinarily complex material via all mediums.
- Must be initiative-taking and self-directed.
- Mastery of analyzing complex data analytics, identification of trends and assessment of potential overpayment vulnerabilities.
- Superior critical thinking skills
- Knowledge of healthcare reimbursement and medical policies as well as payment methodologies.
- Ability to work independently, with minimal supervision.
- Proficiency in Microsoft applications.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
medical codingdata analysispre-payment editingpayment integritydata analyticstrend identificationoverpayment assessmenthealthcare reimbursementmedical policiespayment methodologies
Soft skills
communicationpresentation skillscritical thinkinginitiative-takingself-directedclient consultationcross-functional collaborationclient adoption evangelismdetailed requirements gatheringclinical support
Certifications
Certified Professional Coders (CPC)Certified Coding Specialist-Physician (CCS-P)