Payment Integrity Analyst II

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Payment Integrity Analyst II based in the United States.

• Review, analyze, and complete pre- and post-payment claim audits and appeals in accordance with client policies, CMS guidelines, and healthcare industry standards.
• Apply clinical judgment to evaluate documentation and determine the appropriateness and accuracy of claims.
• Interpret and apply payer policies and regulatory requirements across areas such as itemized bills, DRG reviews, and specialty audits.
• Use relevant systems, tools, and resources to conduct thorough and timely audits, appeals, and payment integrity reviews.
• Analyze healthcare claims, reimbursement information, and supporting documentation to identify discrepancies and potential payment issues.
• Communicate audit findings and conclusions clearly and professionally in both written and verbal formats.
• Manage multiple projects and priorities while meeting established deadlines and quality expectations.
• Participate in clinical team meetings, company meetings, training sessions, educational opportunities, and other relevant activities.
• Collaborate effectively with internal stakeholders and interact professionally with clients and senior-level audiences when required.
• Contribute analytical insights and actionable recommendations that support strategic payment integrity initiatives.
• Perform additional responsibilities as assigned.

• Maintain an active LPN, LVN, and/or RN license.
• Bring at least 1 year of relevant professional experience or an equivalent combination of education and experience.
• Have at least 1 year of experience in healthcare revenue cycle and 1 year of hospital bill auditing experience.
• Demonstrate strong knowledge of claims processing, ICD-10 coding, DRG validation, coordination of benefits, healthcare revenue cycles, and claims reimbursement.
• Have experience in medical bill auditing and/or clinical environments such as operating rooms, intensive care, emergency care, telemetry, medical/surgical units, obstetrics, geriatrics, or orthopedics.
• Experience with health insurance denials and appeals, payer or vendor audits, workers' compensation claims, or prospective, concurrent, and retrospective utilization review is preferred.
• A bachelor's degree in healthcare or a related field is preferred.
• Demonstrate working knowledge of CMS requirements and commercial payer policies.
• Be proficient with Microsoft Office, including Pivot Tables and database management.
• Possess strong analytical, data interpretation, modeling, and complex problem-solving abilities.
• Demonstrate excellent written and verbal communication skills, interpersonal effectiveness, adaptability, and a results-oriented mindset.
• Be comfortable managing multiple projects, setting priorities, and working within committed timelines.
• Show exceptional attention to detail and the ability to perform effectively in a fast-paced, dynamic environment.
• Be capable of working independently while collaborating effectively with broader clinical and business teams.

• Salary range: $66,941–$101,258, with compensation determined by factors including location, experience, qualifications, skills, internal equity, and market conditions.
• Remote work arrangement.
• Medical insurance, including HDHP options with pharmacy coverage.
• Dental and vision insurance.
• Health Savings Account (HSA) and Flexible Spending Account (FSA) options.
• Long-term disability and life insurance.
• Accident and critical illness insurance.
• 401(k) and Roth 401(k) retirement plans.
• Paid time off.
• Pre-paid legal insurance.
• Parking and transit FSA options.
• Opportunities for professional development, training, and career advancement.
• A collaborative environment focused on healthcare payment accuracy, quality, and continuous improvement.