Senior Payment Integrity Analyst - Us Healthcare Job in Coverself

CoverSelf empowers payers and providers with a truly NEXT-GEN cloud-native, holistic & customizable platform preventing and adapting to the ever-evolving claims & payment inaccuracies. Reduce complexity and administrative costs with a unified healthcare dedicated platform. We are backed by top VCs.

We foster an environment of employee empowerment whereby each team member is given the freedom to demonstrate excellence through their skills, character, and background. Our team members are motivated individuals who help each other do remarkable things every day.

About the role:

We're looking for someone who is having extensive knowledge on Payment Integrity or Revenue Integrity or Denial Management. Ex: Medical necessity (LCD & NCD) (must), documentation requirements, frequency limitations, Medicare screeningand other reimbursement payment policies etc.

Responsibilities:

• Identify, Interpret, develop, and implement new concepts that will recognize incorrect payments. Concepts are developed based on industry experience, regulatory research, and ability to analyze medical claim data to discover incorrect claims.
• Owning medical policies end to end.
• Development of Coding guidelines/Medicare/Medicare rules.
• Maintenance of the rules according to industry updates.

Requirements:

• CPC or COC or CPC-P certification
• Extensive knowledge of denials logic from Revenue Integrity, Denials management and Payment Integrity
• Solid knowledge and understanding coding guidelines and medical code sets like CPT, ICD, indicator files etc, coding conventions and rules
• Experience with data collection, analysis, and interpretation
• Strong analytical skills and ability to manage and report complex information
• Ability to work in a fast-paced and dynamic work environment
• Desire to grow professionally, develop new skills and willingness to work outside of comfort zone
• Fluency in Microsoft Word, Excel and adapting skills to new platforms
• Excellent communication (verbal & written) skills
• Good analytical skills and effective stakeholder management
• Exceptional interpersonal skills and demonstrated leadership abilities
• Entrepreneurial at heart and likes to take ownership

Experience: CPC or COC or CPC-P certification with 5+ years of experience in Payment Integrity or Revenue Integrity or Denial Management or Medical Coding with Reimbursement Payment Policies (Medical expertise is must)

Work Location: Bangalore

Work Mode: WFO

Benefits: Best in the Industry Compensation, Friendly & Flexible Leave Policy, Health Benefits, Certifications & Courses Reimbursements, Chance to be part of rapidly growing start-up & the next success story, and many more.

Additional Information:

At CoverSelf, we are creating a global workplace that enables everyone to find their true potential, purpose, and passion irrespective of their background, gender, race, sexual orientation, religion and ethnicity. We are committed to providing equal opportunity for all and believe that diversity in the workplace creates a more vibrant, richer work environment that advances the goals of our employees, communities and the business.