Auditor, Payment Integrity (Chart Review - Remote)
Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together, we will achieve our mission to enhance the health and well-being of the people and communities we serve.
We are looking for a meticulous and analytical Payment Integrity Auditor to ensure accurate claims payment, uphold compliance with regulatory standards, and drive financial integrity through detailed chart reviews and collaborative audit processes.”
Responsibilities:
1. Perform medical chart reviews to ensure provider billing adherence to medical policies and claims payment policies.
2. Review inpatient charts to validate DRG assignment based on ICD-10-CM and ICD-10-PCS coding.
3. Ensure compliance with CMS guidelines, payer policies, and official coding rules.
4. Perform Readmission audits to identify related admissions per claims payment policy criteria.
5. Provide detailed clinical and coding rationale to support audit findings.
6. Collaborate with Providers and Medical Directors to resolve audit disputes.
7. Initiate, verify, and reconcile claim adjustments. Maintain audit documentation.
8. Perform other duties of the Payment Integrity Auditor as required.
Qualifications:
1. Bachelor’s degree in a health care-related field or business-related discipline preferred.
2. Current credentials of CPC, RN, or RHIT/RHIA/CCS.
3. Strong knowledge of medical terminology and ICD-10-CM/PCS coding guidelines.
4. Understanding of Inpatient Prospective Payment System (IPPS), MSDRG, and regulatory requirements and/or Outpatient Prospective Payment System (OPPS).
5. Inpatient Medical Chart Review experience is required.
6. Analytical and detail-oriented with strong problem-solving skills.
7. Excellent communication skills: verbal and written.
8. Intermediate knowledge of MS Office: Excel, Word, Outlook.
Fully Remote:
This role is designated by Independence as fully remote. The incumbent will not be required to report to one of Independence’s physical office locations to perform the work. However, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.
IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Must have an Android or iOS device that is compatible with the free Microsoft Authenticator app
Vaccination Update
This job requires that you demonstrate you have been fully vaccinated for COVID-19 prior to the start of employment, to the extent permitted by law.
About Our Company
AmeriHealth Casualty has been successfully returning employees to work since 1994, providing quality medical treatment and care and reducing costs for our customers. With our affiliates, we serve more than 1,800 businesses in the area and have offices in Philadelphia, Camp Hill, and Pittsburgh, PA, and Mount Laurel, NJ.
In 1994, CompServices, Inc. began offering workers’ compensation third-party administration services for manufacturers, municipalities, health care facilities, social services, transportation risk, universities, and retail firms. In 1996, AmeriHealth Casualty Insurance Company was established as an extension of our workers’ compensation claims services — its mission to provide workers’ compensation insurance combined with high quality claims service and cost containment.
AmeriHealth Casualty Insurance Company and CompServices write premiums and administer self-insured programs for over 1,800 customers.
Equal Employment Opportunity
AmeriHealth Casualty is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Agency Disclaimer
All resumes submitted directly to an AmeriHealth Casualty employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of AmeriHealth Casualty and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by AmeriHealth Casualty or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.