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Apex Systems, an IT staffing and workforce solutions firm, provides recruiting and staffing services to large and small companies alike. Founded in 1995 by three Virginia Tech clas
Payment Integrity Professional
Location
Kentucky
Posted
53 days ago
Salary
$22 - $23 / hour
Seniority
Senior
Job Description
Payment Integrity Professional
Apex Systems
Title: Payment Integrity Professional Employee Type: Contract Remote: Yes Location: Louisville, KY, US Job Type: Date Posted: April 6, 2026 Pay Range: $22 - $23 per hour Job#: 3029181 Job Description: Payment Integrity Professional Location: Louisville, Kentucky (Remote) Employment Type: Contract Role Overview The Payment Integrity Professional contributes to cost reduction by improving the accuracy of provider contract payments and ensuring correct claims payment. This role supports investigations related to fraud, waste, and abuse. The position requires independent judgment to determine the appropriate course of action in ambiguous situations with minimal direction. This role does not involve clinical judgment or medical necessity determinations. Contract Details This role offers an opportunity for extension or conversion to full-time employment. Conversion is not guaranteed and is based on performance, evaluation, and business need. Key Responsibilities - Review and analyze Medicare appeal cases from a non-clinical and coding perspective. - Verify coding accuracy and ensure compliance with Centers for Medicare and Medicaid Services (CMS) guidelines. - Support the Medicare appeals process through detailed review and documentation. - Assist with the management and reporting of SIU grievances, appeals, Independent Review Entity (IRE) overturns, and Administrative Law Judge (ALJ) hearings. - Read, interpret, and analyze medical claims to ensure appropriate payment outcomes. - Apply coding guidelines, correct coding initiatives, national benchmarks, and industry standards. - Monitor compliance and manage assigned inventory. Required Qualifications - AAPC Coding Certification (CPC). - Minimum of two years of post-certification experience applying coding guidelines, preferably with Medicare claims. - Knowledge of CMS guidelines, correct coding initiatives, national benchmarks, and industry standards. - Experience with Medicare Appeals. - Experience reading and interpreting medical claims. - Experience with the Medicare Line of Business. - Experience with compliance monitoring. - Proficiency in CAS, CRM, MHK, Microsoft Word, and Excel. - Strong written communication skills. Preferred Qualifications - Experience working within a Special Investigations Unit (SIU). - Experience with Pareo or MOAT. - Experience leading people, projects, or processes. - Experience in a fast-paced operational setting. - Experience with STARs, G&A IRT, or Maximus. - Investigation experience. - Ability to work independently and manage multiple priorities. - Capacity to maintain confidentiality. - Experience using Strider or Co-Pilot. Work Arrangement This is a remote, work-from-home position. Occasional travel to company offices for training or meetings may be required. Work hours must align with Central or Eastern Time, Monday through Friday. Compensation and Benefits Pay Rate: $22.00/hr - $23.00/hr We are an equal opportunity employer and welcome applications from all qualified candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. Apex Systems is a world-class IT services company that serves thousands of clients across the globe. When you join Apex, you become part of a team that values innovation, collaboration, and continuous learning. We offer quality career resources, training, certifications, development opportunities, and a comprehensive benefits package. Our commitment to excellence is reflected in many awards, including ClearlyRated's Best of Staffing® in Talent Satisfaction in the United States and Great Place to Work® in the United Kingdom and Mexico. Apex uses a virtual recruiter as part of the application process. Apex Benefits Overview: Apex offers a range of supplemental benefits, including medical, dental, vision, life, disability, and other insurance plans that offer an optional layer of financial protection. We offer an ESPP (employee stock purchase program) and a 401K program which allows you to contribute typically within 30 days of starting, with a company match after 12 months of tenure. Apex also offers a HSA (Health Savings Account on the HDHP plan), a SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions, a corporate discount savings program and other discounts. In terms of professional development, Apex hosts an on-demand training program, provides access to certification prep and a library of technical and leadership courses/books/seminars once you have 6+ months of tenure, and certification discounts and other perks to associations that include CompTIA and IIBA. Apex has a dedicated customer service team for our Consultants that can address questions around benefits and other resources, as well as a certified Career Coach. You can access a full list of our benefits, programs, support teams and resources within our ‘Welcome Packet’ as well, which an Apex team member can provide.
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