Under the direction of the Director of Reimbursement and Managed Care Contracting, the Payment Integrity Specialist collects and resolves inpatient and outpatient accounts from governmental, commercial, and/or managed care payers through the efficient analysis of payments in accordance with managed care contracts. Captures accurate reimbursements, pursues underpayments, and appeals denials. Reviews, analyzes, and interprets claims for accuracy of charges, payment in accordance to payer contractual agreements and that reimbursement models are appropriate and complete. Administers payer profiling to assist in contractual review and analysis for Med Center Health Managed Care contract negotiations.
Two years' professional level experience in a healthcare, accounting, finance, or business environment required. Previous experience with third part insurance clams and/or payer contract analysis preferred.
Education & Training:
Bachelor's Degree in Accounting, Finance, Health Care Administration, Business or related degree required. Master's degree preferred.