Integrity Analyst II - DRG Auditor

The Payment Integrity Analyst is responsible for accurately reviewing pre and post pay claim audits based on client, policy, industry standards and/or CMS guidelines.

This is a remote position.

• Reviews, analyzes, and completes internal audits and/or appeals in accordance with client policy, CMS guidelines and industry standards in clear and professional written communication.
• Uses clinical judgement and analytical skills to appropriately review documentation submitted for claim audits.
• Utilizes clinical judgement to interpret and apply client policies along with CMS guidelines as it relates to CERIS reviews such as itemized bill, DRG and/or specialty audits.
• Utilizes applicable tools and resources to complete internal audits and/or appeals.
• Completes internal audits and/or appeals in a timely manner.
• Attend Clinical Team Meetings, All Company Meetings, Education Opportunities, Trainings, and other potential meetings.
• Performs additional duties as assigned.

• Demonstrates understanding of CMS and commercial payer policy in written and verbal format
• Strong understanding of claims processing, ICD-10 Coding, DRG Validation, and Coordination of Benefits
• Strong understanding of healthcare revenue cycle and claims reimbursement
• Proficient in Microsoft Office, including Pivot Tables and Database Management
• Comfortable interfacing with clients and the C‑Suite
• Manages multiple projects, sets priorities, and adheres to committed schedules
• Exhibits strong interpersonal skills and an adaptive communication style with complex problem‑solving skills, drive for results, and innovation
• Excellent written and verbal communication skills
• Proven track record of delivering concrete results in strategic projects/programs
• Strong analytical and modeling ability, distilling data into actionable results
• Superb attention to detail and ability to deliver results in a fast‑paced and dynamic environment.

• Must maintain a current LPN, LVN and/or RN licensure.
• Preferred experience with health insurance denials and/or appeals, payer audits, or vendor audits.
• Previous experience in one or more of the following areas is required:
• Medical bill auditing
• Experience in the acute clinical areas of facilities in O.R., I.C.U., C.C.U., E.R., Telemetry, Medical/Surgical, OB or L&D, Geriatrics and Orthopedics
• Knowledge of worker's compensation claims process
• Prospective, concurrent and retrospective utilization review
• Bachelor’s degree in healthcare or a related field preferred.
• 1+ years healthcare revenue cycle experience.
• 1+ years of relevant experience or an equivalent combination of education and work experience.
• 1+ year of hospital bill audit experience.

Cor Vel uses a market‑based approach to pay, and salary ranges may vary depending on your location. Pay rates are established taking into account federal, state, and local minimum wage requirements, geographic location, job‑related skills, experience, qualifications, internal employee equity, and market conditions. Ranges may be modified at any time. Brackets and level adjustments will be clarified during the offer process.

Pay Range: $65,436 – $98,982.

A list of our benefit offerings can be found on our Cor Vel website.

CERIS, a division of Cor Vel Corporation, a certified Great Place to Work® Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in healthcare payments. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities.

We embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE‑IT!). A comprehensive benefits package is available for full‑time regular employees and includes Medical (HDHP w/Pharmacy), Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre‑paid Legal Insurance, Parking and Transit FSA accounts, 401(K), ROTH 401(K), and paid time off.

Cor Vel is an Equal Opportunity Employer, drug‑free workplace, and complies with ADA regulations as applicable.