Remote Payment Integrity Team Lead - QA & Claims
CorVel Corporation
- Remote job
CorVel Corporation seeks a Payment Integrity Analyst III - QA Analyst to lead the PPI team and conduct audits per CMS guidelines and client policy. The role requires strong clinical judgment, attention to detail, and expertise in revenue cycle processes. This remote position supports multiple clients with quality assurance responsibilities. The ideal candidate will have 3+ years in healthcare revenue cycle or payment integrity, experience with denials/appeals, and proficiency in data analysis #J-18808-Ljbffr CorVel
$73.35k - $113.25k
...Description Job Description The Payment Integrity Analyst (Team Lead) assists with leading the Policy and... ...accurately reviewing pre and post pay claim audits based on client, policy,... ...various healthcare policies. This is a remote position. ESSENTIAL FUNCTIONS &...Remote workClaimsMinimum wageFull timeWork experience placementWork at officeLocal areaFlexible hours- ...Auditing payer claims across multiple lines of business, the full-time remote Payment Integrity Specialist will identify improper payments, quantify recoveries, and generate new audit concepts while maintaining high-quality standards and meeting monthly financial goals...Remote workClaimsFull time
- ...Job Title: Payment Integrity Auditor / Data Mining Auditor Location: Remote Schedule: Full-time (40 hours/week) | Monday–Friday, 8:0... ...Auditor to join our Audit Operations team. In this role, you will analyze paid medical claims data feeds received from providers on...Remote workClaimsDaily paidFull timeContract workMonday to Friday
$75k - $90k
...opportunities, confirms claim repricing accuracy and... ...pricing rules, and claim payment methodologies. The... ...qualifications) Location: 100% Remote (U.S.-based) Up to 10% annual travel (for team meetings and limited... ...auditing, Payment Integrity, coding, claim quality...Remote workClaimsFull timeContract workTraineeship- ...Payment Integrity Specialist New Skills Collaboration Software Dashboard... ...Fraud Detection Healthcare Claims Processing Reporting Tools... ...Collaborate with healthcare operations teams to improve processes.... ...abilities. Job Type: Remote Salary: Not Disclosed Experience...Remote workClaims
- CorVel Corporation is seeking a Payment Integrity Analyst to review pre and post pay claim audits, applying CMS guidelines and client policies. This is a remote position with responsibilities spanning... ..., and coordination with clinical teams.The role requires licensure (LPN/...Remote jobClaims
- ...Senior Product Manager for Professional Claims Review - Payment Integrity. You will define strategy, own roadmaps, and guide cross-functional teams including engineering, analytics, and... ...client value. This role offers remote work anywhere in the U.S. with in-office...Remote jobClaimsWork at office
- PacificSource seeks a Payment Integrity Analytics Specialist to transform complex claims data into actionable insights. You will build dashboards and reports to monitor... ..., and experience with Power BI or Tableau. This remote role offers strategic impact across payment...Remote workClaims
$66.94k - $101.26k
The Payment Integrity Analyst is responsible for accurately reviewing... ...pre- and post pay claim audits based on client... ...guidelines. This is a remote position. ESSENTIAL... ...appeals Attends clinical team meetings, company... ...(I, II, III, Senior, Lead, etc.) new hires may be...Remote workClaimsMinimum wageFull timeWork experience placementWork at officeLocal areaFlexible hours- ...Acquisition at nTech Workforce Title: Payment Integrity Specialist Location: 100 % Remote, but Candidates must be based in... ...& Responsibilities Work with a leading healthcare payer within their... ...healthcare providers warrants a change in claim payment. This is a non-phone,...Remote workClaimsContract work
$166k - $220k
...experienced EW Mission Integration Lead with prior training... ...and accelerate cross-team projects spanning multiple... ....Conduct onsite and remote troubleshooting support... ...often attempt to extract payment or sensitive personal... ...fraudulent outreach claiming to be from Anduril, please...Remote workClaimsFull timeContract workWork experience placementImmediate start$112.7k - $193.2k
...strategy for one of Optum Payment Integrity's Intelligent Fraud... ...organizations ensure claims are paid accurately and... ...flexibility to work remotely * from anywhere within... ...analytics and finance teams to evaluate product ROI... ...enabled platformsExperience leading or mentoring other...Remote workClaimsMinimum wageFull timeWork experience placementWork at officeLocal areaShift work$112.7k - $193.2k
...The work you do with our team will directly improve health... ...strategy for one of Optum Payment Integrity's Professional Claim Review products. These are... ...the flexibility to work remotely * from anywhere within the... ...scalability and client success-Lead Product Development and...Remote workClaimsMinimum wageFull timeWork experience placementWork at officeLocal areaShift work- ...Integration Lead HealthEdge® offers AI-powered operational... ...programs Integrate Claims, Enrollment, Provider, Authorization, Payment systems Ensure architecture... ..., and internal product teams Identify... ...Comfortable in a fully remote environment that relies...Remote workClaimsPermanent employmentFull timeWork experience placementWork at office
- ...Medical Director, Clinical Payment Integrity provides clinical... ...Legal, and Compliance teams to advance payment accuracy... ...documentation, claims data, coding practices... ...healthcare executives. Lead provider discussions regarding... ...capabilities. Fully Remote: This role is...Remote workClaimsWork at office
$86.4k - $138.6k
## Manager Payment IntegrityApply: Remote: PA, Working at Home - Pennsylvania: Full time... ...pre-payment high dollar claims review process for Highmark... ...Management, Facility Revenue Cycle Teams, Provider Relations and... ...other areas within Payment Integrity to provide consulting on...Remote workClaimsFull timeWork at officeWork from home$100.6k - $132.04k
...Manager, Data Mining to join our Payment Integrity team. Oscar is the first... ...The Manager of Data Mining leads a team of individual contributors... ...Work Location: This is a remote position, open to candidates... ...Experience with healthcare claims adjudication ~ Experience...Remote workClaimsFull timeWork at office$87.7k - $157.8k
...Monitor business processes and systems to assure integrity and compliance in billing and claims payment Lead teams of analysts to appropriately investigate all... ...holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual...Remote workClaimsFull timeContract workPart timeWork at officeImmediate startFlexible hours$73k - $125k
...conducting prepayment and post-payment clinical reviews of... ...The auditor reviews claims and medical records for... ..., and Payment Integrity guidelines. This role... ...management, and other internal teams to address complex,... ...and meet deadlines in a remote work environment. Communication...Remote workClaimsFull timeContract workInternship$76.9k - $100k
...those who need it most. Clover’s Payment Integrity team is responsible for ensuring claims are paid accurately, consistently... ...the Senior Manager, who will lead complex SQL development, investigation... .... Additionally, we embrace a remote-first culture that supports collaboration...Remote workClaimsFull timeContract workWork experience placementWork at officeFlexible hours- ...Health in Illinois seeks an Initiative Project Leader for Payment Integrity Unified Ecosystem. The role requires in-office presence 3... ...communicate status to executives, while guiding cross-functional teams across Claims, Operations, IT, Finance, and Digital. #J-18808-Ljbffr...ClaimsWork at officeFlexible hours3 days per week
$133.2k - $180.9k
...commitment of our team members. That's... ...Adjustment & Revenue Integrity Analytics Lead Position Summary... ...data from claims, encounters, eligibility... ...the Diagnosis-to-Payment Lifecycle: Trace... ...validation, QA, and reconciliation... ...conditions. #LI-REMOTE Pay...Remote workClaimsFull timeWork at officeVisa sponsorshipShift work$156.1k - $223k
...Be part of a team that unleashes the power of leading-edge technologies to help improve... ...Summary The VP, Payment Integrity is responsible for developing... ...following solutions: Clinical Claim Reviews (DRG Audit,... ...in this role ~ A 100% remote role with travel based on...Remote workClaimsFull timeContract workTemporary workFlexible hours$94.9k - $130.5k
...community The Program Integrity (PI) Contract Lead is an important member of the leadership team and works directly... ...3, the Federal False Claims Act, and applicable state... ...Integrity and/or Payment Integrity experience... ...Information Work Style: Remote Work at Home Requirements...Remote workClaimsWeekly payOngoing contractFull timeContract workTemporary workWork at officeWork from homeHome office- ...The Senior Lead of Carrier Engagement is responsible... ...carriers and internal teams, the Senior Lead drives... ...communication, operations, payment processes, and... ...championing operational integrity, strengthening partnerships... ...understand and explain claims and billing data ~...ClaimsFull time
- ...member experience to payment integrity, provider quality, and... ...healthcare cost pressures, claims performance, and... ...Operations, Revenue, and other teams, you’ll translate... ...existing services. Lead strategic business... ...ll Work: This is a remote position with travel,...Remote workClaimsFull timeImmediate startFlexible hours
$80k - $120k
...Machinify is a leading healthcare intelligence... ...across the payment continuum,... ...Payment Solutions Team, the Concept... ...commercial healthcare claim types to lead... ...of payment integrity audit concepts.... ...Perform QA reviews of audit... ...independently and in a remote environment,...Remote workClaimsFull timeWork at officeFlexible hours- ...is seeking an experienced Senior Payment Integrity Analyst to serve as a key business lead for payment integrity across our... ...detect, and recover improper medical claims while working closely with... ..., Compliance, Finance, and other teams to implement solutions Analyze...Remote workClaimsFull timeContract workWork experience placement
- Managing moderately complex Payment Integrity systems analysis, the full-time Payment Integrity... ...reporting, and workflow analysis while working remotely across various states. Key... ...Payment Integrity platform outputs and claims system data to identify exceptions and...Remote workClaimsFull time
- ...DQ) Analyst Healthcare Data Integration Experience: 5 8+ Years Location: Hybrid / Remote Job Overview We are... ...healthcare domains such as Claims, Member, Provider, or Clinical... ...with business, engineering, QA, and technical teams to define and validate data...Remote workClaims
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