Immediate Opening For Payment Integrity

Hi we are Hiring!!

Coders with Experience of Payment Integrity!!

Job Summary:

The Payment Integrity Analyst is responsible for identifying, investigating, and resolving payment discrepancies to ensure that payments made to healthcare providers, vendors, or claimants are accurate, compliant with regulations, and in accordance with contractual agreements. This role plays a critical part in ensuring that the organization maintains financial accuracy, prevents fraud, and upholds regulatory standards.

Key Responsibilities:

• Payment Accuracy and Auditing:
• Review and validate payments against contracts, pricing agreements, and policies.
• Perform audits on payment transactions to ensure accuracy, including overpayments, underpayments, and duplicate payments.
• Reconcile discrepancies between claims and payments.
• Investigate payment variances and collaborate with internal stakeholders to resolve issues.

Claims and Billing Reconciliation:

• Ensure all claims are processed accurately and within service level agreements (SLAs).
• Coordinate with claims, billing, and customer service departments to address and resolve any issues related to payments and claims.
• Review payment records for discrepancies, incomplete information, or missing documentation.

Fraud Prevention and Detection:

• Identify patterns or anomalies that may indicate fraudulent activity or abuse.
• Conduct regular reviews of payment data to detect overpayments or improper billing practices.
• Implement fraud prevention measures, including system checks, cross-checks with external databases, and reviewing historical trends.

Reporting and Documentation:

• Prepare reports on payment integrity trends, discrepancies, and findings.
• Document all findings, resolutions, and action steps taken.
• Maintain and update internal payment records, logs, and systems to ensure audit trails are complete and accurate.

Collaboration and Communication:

• Work closely with internal departments to resolve payment issues and ensure compliance with agreements.
• Respond to provider or vendor inquiries regarding payment discrepancies, investigations, and resolution.
• Educate internal teams about payment integrity best practices, policies, and procedures.

Process Improvement:

• Assist in the development and implementation of process improvements to enhance payment accuracy and efficiency.
• Provide feedback to improve claims processing systems, payment workflows, and automation tools.

Compliance and Regulatory Standards:

• Ensure all payment activities comply with applicable federal and state regulations, as well as internal policies and contractual agreements.
• Stay current on regulatory changes and industry standards to ensure ongoing compliance in payment processing.

Qualifications:

• Relevant certifications (e.g., Certified Professional Coder (CPC), Certified Payment Integrity Specialist (CPIS), or equivalent).

Experience:

• 1-3 years of experience in payment integrity, claims processing, billing, auditing, or a related field (preferably in healthcare or insurance).
• Experience in identifying and resolving payment discrepancies, fraud prevention, or financial auditing.
• Familiarity with payment systems, claims processing platforms, and billing software.
• Immediate Joiners Preferred.

Skills:

• Strong analytical and problem-solving skills with attention to detail.
• Ability to investigate complex payment issues and resolve them effectively.
• Proficient in Microsoft Office Suite (Excel, Word, Outlook); familiarity with claims management or payment systems (e.g. Ex-CAP) is a plus.
• Knowledge of healthcare regulations (e.g., HIPAA, ACA), payment integrity best practices, and industry standards.
• Excellent written communication skills, with the ability to document the complex issues.

Perks & Benefits

5 Days of Working

Complete Day Shift

Saturday & Sunday Fixed Off

Double Wages(If working on Saturday)

Thanks

HR Team