Certified Payment Integrity Lead

Job Summary

A company is looking for an Enterprise Payment Integrity Lead.

Key Responsibilities:

• Analyze hospital claims to identify coding errors and ensure accurate overpayment recovery
• Design and implement pre and post-payment review programs, focusing on audits and data mining
• Develop plans to transition post-payment controls to pre-payment to minimize future overpayments

Required Qualifications:

• High School Diploma/GED required; Bachelor's degree in a relevant field preferred
• Minimum of 5 years of experience in payment integrity or revenue cycle management
• At least 3 years of experience in project implementation
• Experience in the health insurance industry is required
• American Academy of Professional Coders certification(s) required