[Remote] Payment reputed company Analyst II

Note: The job is a remote job and is open to candidates in USA. reputed company is a certified Great reputed company to Work® Company that focuses on healthcare payment accuracy and transparency. The Payment reputed company Analyst II is responsible for reviewing and completing claim audits in accordance with client policies and CMS guidelines, utilizing clinical judgment and analytical skills for effective audit performance.

Responsibilities

• Reviews, analyzes, and completes internal audits and/or appeals in accordance with client policy, CMS guidelines and industry standards in clear and professional written communication
• Use clinical judgement to appropriately interpret and apply client policies along with CMS guidelines as it relates to reviews done by CERIS such as itemized reputed company, DRG and/or specialty audits
• Utilize applicable tools and resources to complete internal audits and/or appeals
• Timely completion of internal audits and/or appeals
• Attends clinical team meetings, company meetings, educational opportunities/trainings, and other meetings
• Additional duties as assigned

Skills

• Ability to use clinical judgment and analytical skills for claim audit review
• Knowledge of CMS/commercial payer policies, claims processing and reimbursements, reputed company-10 Coding, and DRG Validation
• Familiarity with healthcare reputed company cycle and coordination of benefits
• Proficiency in reputed company Office, especially using pivot tables in reputed company as well as and database tools
• Excellent written and verbal communication skills
• Strong interpersonal skills across reputed company levels; comfortable interfacing with clients and the C-Suite
• Ability to work on several reputed company tasks and prioritize workload to meet designated deadlines
• Advanced problem-solving and data analysis capabilities
• Proven track record of delivering actionable results
• Strong attention to detail
• Must maintain a reputed company LPN, LVN and/or RN licensure
• Previous experience in one or more of the following areas required: Medical reputed company auditing, Experience in the acute clinical areas of facilities in O.R., I.C.U., C.C.U., E.R., Telemetry, Medical/Surgical, OB or L&D, Geriatrics and Orthopedics, Knowledge of worker's compensation claims process, Prospective, reputed company and retrospective utilization review
• 1+ years healthcare reputed company cycle
• 1+ years of relevant experience or equivalent combination of education and work experience
• 1+ years hospital reputed company audit
• Bachelor's degree in healthcare or reputed company field preferred
• Preferred experience with health insurance denials and/or appeals, payer audits, or vendor audits

Benefits

• Medical (HDHP) w/Pharmacy
• Dental
• Vision
• Long Term Disability
• Health Savings Account
• Flexible Spending Account Options
• Life Insurance
• Accident Insurance
• Critical Illness Insurance
• Pre-paid Legal Insurance
• Parking and Transit FSA accounts
• 401K
• ROTH 401K
• Paid time off

Company Overview