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.

• You will be responsible for providing coding and abstracting services for clients on physician medical records using ICD 10-CM, CPS, and CPT coding systems. • You will use established coding principles, software, and your knowledge and experience to assign diagnostic and procedural codes after a thorough review of the medical record. • You will participate in industry forums and support coding education within the team. • Reviews medical records to identify pertinent diagnoses and procedures relative to the patient's health care encounter. • Selects the principal diagnosis and principal procedure, along with other diagnoses and procedures using UHDDS definition. • Ensures appropriate DRG assignment. • Abstracts appropriate information from the medical record based on the guidelines provided by the client and after a thorough review of the medical record. • Consistently meet productivity and quality performance requirements. • Responsible for utilizing applications to enter charts coded in real-time throughout the scheduled shift. • Solicits clarification from the physician regarding ambiguous or conflicting documentation in the medical record using guidelines provided by the client. • Participate in team meetings and all training required by IKS staff or client. • May be asked to participate in training or shadowing of other coders. • Flexibility in assignment over multiple clients to ensure meeting required classification hours. • Participate in Coding Roundtables through presentation of materials, articles and current issues related to coding and Health Information Management. • Maintains current knowledge of the information contained in the Coding Clinic, CPT Assistant, and the Official Guidelines for Coding and Reporting. • Participates in education modules as assigned. • Responsible for keeping coding credentials up to date and active. • Maintains effective and professional communication skills. • Contributes to a positive company image by exhibiting professionalism, adaptability, and mutual respect.

The CERIS Certified Coder reverse codes previously coded medical bills to determine coding accuracy. This role is responsible for making claim-related recommendations and communicating status of the claim to involved stakeholders. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: - Receives claim and processes based on state rules and regulations - Determines validity and compensability of the claim using CorVel proprietary programs - Makes recommendations and communicates claim status to to referring office - Read and comprehend all medical reports - Adhere to client and carrier guidelines and participate in claims review as needed - Assists other claims professionals with more complex or problematic claims as necessary - Maintain HIPAA compliance - Additional duties as assigned KNOWLEDGE & SKILLS: - Ability to learn rapidly to develop knowledge and understanding of claims practices - Strong organizational skills - Ability to meet or exceed performance competencies - Effective and professional verbal and written communication skills - Ability to handle demanding situations while using critical and strategic thinking skills - Demonstrated outstanding leadership, problem solving, and analytical skills - Ability to think and work independently, while working in an overall team environment - Proficient in Microsoft Office, especially Excel and Outlook EDUCTION & EXPERIENCE: - High School diploma or equivalent - Current AAPC certification (which must be maintained throughout employment as current and active status) - Certification as CPC with the AAPC for more than 2 years (w/ surgical or office experience) - Current or recent orthopedic billing/coding experience - EncoderPro software experience - E/M coding/down-coding experience - Texas workers' compensation experience is preferred - Pain Management/Anesthesia/General Surgery coding experience is preferred PAY RANGE: CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process. Pay Range: $48,143 – $71,852 A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first. ABOUT CERIS: CERIS, a division of CorVel Corporation, a certified Great Place to Work® Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in healthcare payments. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities. We embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!). A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off. CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable. #LI-Remote

• Case Review & Coding: Review individual coding cases (estimated 30–45 minutes per case), applying accurate medical codes in line with project guidelines and standards. • Quality Assurance & Data Accuracy: Ensure consistent and accurate application of medical codes following provided guidelines and project standards. • Platform-Based Review: Use a dedicated labeling platform to review, code, and validate cases efficiently. • Feedback & Collaboration: Provide feedback to improve coding guidelines, identify ambiguities in source data, and support the improvement of AI-assisted coding mappings.