Payment Integrity Analyst (inpatient) Job in Coverself

Job Responsibilities:

• Identify, Interpret, develop, and implement new concepts that will recognize incorrect payments. Concepts are developed based on industry experience, regulatory research, and ability to analyze medical claim data to discover incorrect claims.
• Owning medical policies end to end.
• Development of ICD-10 CM, PCS Coding guidelines, AHA coding clinics, UHDDS guidelines, Medicare/Medicare rules.
• Identifies data trends and suggests resolutions and opportunities for process improvement.
• Updating and developing new and current audit recovery reports (OIG audit trends), developing and running custom queries.
• Researching reimbursement regulations for claim payment compliance reviews and documentation to support current audit findings

Requirements:

• CIC or CCS certified
• Solid knowledge and understanding of clinical criteria documentation requirements to successfully substantiate code assignments.
• Demonstrated understanding of the APR-DRG, MS-DRG, ICD-10, clinical criteria, and clinical review judgement.
• Demonstrated proficiency in medical record analysis and ICD-10-CM and PCS coding methodologies.
• Well updated with AHA coding clinics, UHDDS guidelines.
• Solid knowledge and understanding coding guidelines and medical code sets like PCS, MDC, DRG, CPT, ICD, indicator files etc, coding conventions and rules.
• Demonstrated experience in medical review, chart audits, and quality improvement processes.
• Experience with data collection, analysis, and interpretation.
• Well updated with claim forms, denial management for inpatient.
• Desire to grow professionally, develop new skills and willingness to work outside of comfort zone.
• Ability to work in a fast-paced and dynamic work environment.
• Excellent communication (Verbal & Written) and strong interpersonal skills
• Good analytical skills and effective stakeholder management.
• Exceptional interpersonal skills and demonstrated leadership abilities
• Entrepreneurial at heart and likes to take ownership

Experience: CIC or CCS certified with 5+ years experience in payment integrity or revenue integrity or IP denials Management, Minimum 4+ years of experience in Inpatient claim audit or Reimbursement IP policies