Integrity Specialist W2

Senior Specialist, Talent Acquisition at nTech Workforce

Title:

Payment Integrity Specialist

Location:

100 % Remote, but Candidates must be based in EST or CST and must be comfortable working EST-hours

Terms of Employment

• This position is 100% remote. Candidates must be based in EST or CST and must be comfortable working EST-hours. Candidates based in Washington, DC, Maryland, or Virginia are preferred, but not required.

Overview & Responsibilities

• Work with a leading healthcare payer within their Payment Integrity division. Unlike traditional enrollment roles, this position focuses on the analytical side of healthcare finance. You will be responsible for reviewing medical correspondences, analyzing itemized bills, and determining if additional documentation provided by healthcare providers warrants a change in claim payment. This is a non-phone, research-heavy role perfect for someone with a strong background in claims, medical coding, or payment integrity systems.
  
  You will…
• Analyze medical record documentation and correspondences to understand routing requirements.
• Utilize systems such as Facets, NASCO, and Conduit (SIR) to look up member information and claim details.
• Update and maintain detailed spreadsheets in Excel with notes regarding received documentation.
• Review ICD-10 and CPT codes to identify denial reasons and coordinate with vendors for final claim review.
• Route itemized bills and medical records to the appropriate internal parties for payment integrity review.

Required Qualifications

• High School Diploma or GED and 3+ years of experience in healthcare claims, medical billing, or member services.
• Strong proficiency in Microsoft Excel.
• Experience with the Facets.
• Prior experience analyzing medical records and possess an understanding of basic ICD-10 and CPT coding.
• Exceptional attention to detail for data entry and record-keeping.

Preferred Qualifications

• Previous experience in a Payment Integrity or Appeals unit.
• Familiarity with NASCO or Conduit (SIR) systems.

• Mid-Senior level

• Contract

• Health Care Provider
• Industries:
  Hospitals and Health Care, Public Health, and Health and Human Services