Payer Integrity Specialist
Position Summary
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.
Minimum Qualifications
Work Experience
Professional level experience in a healthcare, accounting, finance, or business environment preferred.
Previous experience with third party insurance clams and / or payer contract analysis preferred.
Education
Bachelor’s Degree in Accounting, Finance, Health Care Administration, Business or related degree required.
Master’s degree preferred.
Certifications / Licensure
None required.
Job Specific Performance Standards
The duties listed below are a summary of the major essential functions of this position. The position may require other duties, both major and minor, that are not mentioned, and specific functions may change from time to time.
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Integrity Specialist • Bowling Green, Kentucky, United States, 42101