Payer Integrity Specialist - Med Center Health : Job Details

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...Specialist, Integrity, Health, Payment, Accounting, Healthcare, Business Services