Payment Integrity Specialist

HealthComp

Remote, United States

Now is the time to join us! 

Who are you?

The Payment Integrity Specialist will be a team member of the Payment Integrity Department. The job summary includes preparing negotiate templates to be used with negotiating with providers, negotiating with providers, preparing itemized bill review templates that will be completed by physicians, RNs, and PAs. This position requires employee to meet minimum keep performance indicators that are measured and updated frequently.

In this role you will wear many hats, but your knowledge will be essential in the following:  

• Utilize OCR software to extract rev code detail out of provider itemized bill and feed this data into the Itemized Bill Review Template
• Utilize OCR software to extract UB04 data and feed this data into the Itemized Bill Review Template
• Assist with Single Case Agreements
• Assist with SIU (special investigation unit), Modifier and Coding requests by retrieving all of the documentation needed from UM Web and other sources and coordinate with RN Coder and physicians along with requesting parties.
• Pend Out-of-network claims are for fee negotiations or for High Dollar Review once all necessary information has been received in order to process the claim.
• Research the claim and all available pricing allowances for the services rendered.
• Contact the provider to initiate open negotiations on the claim(s) and follow up as often as necessary.
• If still unsuccessful, process the claim with appropriate discount to achieve savings
• Documented notes with the providers contact information, terms ofvthe agreement, and any updates regarding status of the negotiations, counteroffers received, etc.
• Once the negotiated amounts have been finalized with the Provider during the open negotiation period, the negotiator will draft the LOA and send to the provider to sign.
• nce the fully executed LOA is returned to HealthComp the claim will be processed according to the LOA.
• Apply Applicable interest will be applied to the claim.
• Apply Applicable savings fees are processed in El Dorado, documenting the savings achieved and related fees.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

What you bring to the Personify Health team:

In order to represent the best of what we have to offer you come to us with a multitude of positive attributes including:

• At least 5 years working in a healthcare third party administrator, or revenue cycle provider setting or stop loss carrier, or health care insurance broker
• At least a high school degree
• Experience utilizing healthcare billing terms and software involving rev codes, CPT codes, diagnosis codes, DRGs, relative based pricing, etc.

You also take pride in offering the following Core Skills, Competencies, and Characteristics:

• Healthcare TPA Software
• Revenue Cycle management software
• OCR Software
• Medical Coding knowledge
• Microsoft Excell
• Google Docs Sheets
• SmartSheets
• Microsoft Word
• Self-Driven
• Team Player
• Highly Motivated
• Desire to be a part of team and contribute to a larger effort
• Innovative

No candidate will meet every single desired qualification. If your experience looks a little different from what we’ve identified and you think you can bring value to the role, we’d love to learn more about you!

Personify Health is an equal opportunity organization and is committed to diversity, inclusion, equity, and social justice.

In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges from $20.00-$25.00(hourly) Note that salary may vary based on location, skills, and experience. This position is eligible  health, dental, vision, mental health and other benefits.