Payment Integrity Professional

WORK STYLE: Remote/Work at Home. While this is a remote position, occasional travel for training or meetings may be required.

WORK HOURS: Typical business hours are Monday-Friday, 8 hours/day, 5 days/week. Work hours must align to CST or EST.

Aquent is partnering with a leading organization in the healthcare sector dedicated to enhancing the accuracy of payments and ensuring compliance within complex regulatory frameworks. This organization is committed to cost reduction and maintaining the integrity of healthcare systems, ultimately impacting patient care and financial stewardship.

Are you a meticulous coding professional with a passion for ensuring accuracy and compliance in healthcare payments? We are seeking a highly skilled individual to join our client's team and make a significant impact on their mission to uphold payment integrity. In this vital role, you will be at the forefront of supporting investigations into fraud, waste, and abuse, directly contributing to substantial cost reductions and safeguarding the financial health of the organization. Your expertise in Medicare coding and regulations will be crucial in reviewing and analyzing appeal cases, verifying accuracy, and ensuring adherence to critical guidelines, all without involving clinical judgment. This is an exciting opportunity to leverage your analytical prowess and independent judgment to drive positive change and contribute to a more efficient and compliant healthcare landscape.

What You'll Do:

• Contribute to overall cost reduction by increasing the accuracy of provider contract payments and ensuring correct claims processing within payer systems.
• Play a vital role in supporting investigations related to fraud, waste, abuse, and financial recovery efforts.
• Assist with the management, review, and reporting of grievances, appeals, Independent Review Entity (IRE) overturns, and Administrative Law Judge (ALJ) hearings.
• Review and analyze Medicare appeal cases from a non-clinical and coding perspective, focusing on verifying coding accuracy.
• Ensure compliance with Medicare guidelines and support the appeals process through detailed review and documentation.
• Apply strong knowledge of medical coding and Medicare regulations to diverse work assignments, requiring careful interpretation and independent judgment to determine the appropriate course of action.

Must-Have Qualifications:

• AAPC Coding Certification - CPC
• Minimum 2 years of post-certification experience applying coding guidelines by reading and interpreting claims, with a preference for Medicare claims.
• Exceptional understanding of Centers for Medicare & Medicaid Services (CMS) guidelines, correct coding initiatives, national benchmarks, and industry standards.
• Proficiency with Microsoft Word and Excel.
• Demonstrated experience with Medicare Appeals.
• Proven ability to read and understand medical claims.
• Experience working specifically with the Medicare Line of Business.
• Experience monitoring compliance and inventory.
• Strong written communication skills, with an emphasis on clarity and grammar.

Nice-to-Have Qualifications:

• Experience working within a Special Investigations Unit (SIU).
• Experience leading people, projects, and/or processes.
• Experience in a fast-paced operational setting.
• Familiarity with Medicare STARs programs.
• Investigation experience.
• Strong attention to detail.
• Ability to work independently and determine appropriate courses of action.
• Capacity to handle multiple priorities effectively.
• Commitment to maintaining confidentiality.
• Excellent organizational skills.

The target hiring compensation range for this role is $21 to $23 an hour. Compensation is based on several factors including, but not limited to education, relevant work experience, relevant certifications, and location.

About Aquent Talent:

Aquent Talent connects the best talent in marketing, creative, and design with the world's biggest brands.

Our eligible talent get access to amazing benefits like subsidized health, vision, and dental plans, paid sick leave, and retirement plans with a match. We also offer free online training through Aquent Gymnasium. More information on our awesome benefits!

Aquent is an equal-opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics. We're about creating an inclusive environment-one where different backgrounds, experiences, and perspectives are valued, and everyone can contribute, grow their careers, and thrive.

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