Integrity Specialist
Listed on 2026-02-28
-
Healthcare
Healthcare Administration, Healthcare Compliance, Healthcare Management, Medical Billing and Coding
Bham-Corporate Office
Birmingham, AL 35203, USA
Payment Integrity Specialist
Location: Birmingham, AL
Why VIVA HEALTH?
VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.
VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high‑performing health plan and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.
- Comprehensive Health, Vision, and Dental Coverage
- 401(k) Savings Plan with company match and immediate vesting
- Paid Time Off (PTO)
- 9 Paid Holidays annually plus a Floating Holiday to use as you choose
- Tuition Assistance
- Flexible Spending Accounts
- Community Service Time Off
- Life Insurance and Disability Coverage
- Employee Wellness Program
- Training and Development Programs to develop new skills and reach career goals
The Payment Integrity Specialist supports the organization’s payment integrity activities by researching claim payment issues, claim adjustments, and recoupments based on established policies, procedures, and vendor‑identified findings. This entry‑level role assists with claim adjustments, pricing validation, and recoupment activities by reviewing vendor findings, processing claim corrections, and coordinating internal follow‑up in accordance with health plan policies, provider contracts, and regulatory requirements.
Key Responsibilities- Receive, log, and track payment integrity findings from the vendor.
- Process claims adjustments, reversals, and recoupments in the claims processing system following documented procedures.
- Assist with pricing validation using established fee schedules and payment rules.
- Initiate recoupment transactions for confirmed over payments following defined procedures.
- Ensure actions align with policies, contracts, and regulatory guidelines.
- Support research for payment integrity audit findings.
- Serve as a point of contact for payment integrity vendor activities related to adjustments, pricing discrepancies, and recoupments.
- High School diploma or GED
- At least 1–3 years of healthcare claims processing experience, including adjustments or payment research
- Basic understanding of healthcare claims and reimbursement concepts
- Strong attention to detail and accuracy
- Ability to follow established procedures and meet productivity standards
- Effective written and verbal communication
- Strong organizational and time‑management skills
- Ability to work independently within defined guidelines
- Associates degree or higher
- Experience in payment integrity, recovery auditing, or over payment recovery
- Experience with health plan claims systems
- Knowledge of Centers for Medicare & Medicaid Services (CMS) guidelines and payer payment policies
- Working knowledge of claim edits, payment methodologies, and adjustment workflows
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
(If this job is in fact in your jurisdiction, then you may be using a Proxy or VPN to access this site, and to progress further, you should change your connectivity to another mobile device or PC).