Payment Integrity Specialist

GeneralGeneralFull TimeRemoteSeniorTeam 1,001-5,000H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

1 day ago

Salary

$70K - $86K / year

Seniority

Senior

Bachelor Degree3 yrs expEnglish

Job Description

Payment Integrity Specialist

GeneDx

• Monitor internal and external audits related to claims, payments, and refunds • Conduct periodic audits of payer contracts and payment activity to ensure compliance with MFN laws and contractual terms • Identify and escalate discrepancies in payment rates, coding, and authorization processes • Review and process refund requests from payers and patients • Ensure timely and accurate posting of payments and resolution of denials • Maintain detailed records of transactions and audit findings • Validate that payments align with negotiated payer contracts and MFN provisions • Collaborate with legal and contracting teams to interpret and apply MFN rules • Support payer configuration reviews and contract audits • Stay current on federal and state regulations impacting payment integrity, including MFN laws • Ensure audit processes and documentation meet compliance standards • Assist in preparing responses to regulatory inquiries and payer audits • Partner with appeals, credentialing, and market access teams to resolve payment issues • Provide feedback and process improvement recommendations to operational teams • Participate in payer meetings and internal workgroups to enhance audit and payment workflows

Job Requirements

  • Bachelor’s degree in healthcare administration, finance, or related field (or equivalent experience)
  • 3–5 years of experience in medical billing, payment integrity, or payer contract auditing
  • Strong understanding of MFN laws, payer policies, and healthcare reimbursement models
  • Proficiency in claims management systems and data analytics tools
  • Exceptional attention to detail, analytical thinking, and problem-solving skills
  • Excellent communication and documentation abilities
  • CPCS or similar certification preferred

Benefits

  • Competitive compensation and benefits
  • Health insurance
  • Paid time off
  • Flexible work arrangements
  • Professional development opportunities

Related Job Pages

More General Jobs

Diversified Radiology logo

Pediatric Radiologist – Overnight

Diversified Radiology

Why accept "good enough" when better is possible?

General1 day ago
Full TimeRemoteTeam 51-200H1B No Sponsor

• Join Diversified Radiology's Subspecialized Overnight Pediatric Radiology Section • Provide 24/7 pediatric subspecialty coverage for hospitals nationwide through a collaborative, multi-shift model that promotes exceptional patient care, balanced workloads, and physician support.

United States
$500K / year
Full TimeRemoteTeam 10,001+Since 1886H1B No Sponsor

• Identify, capitalize on, and negotiate for opportunities to grow the base business, increase sales, optimize display space, and improve productivity while maintaining excellent customer service. • Assist with the installation and maintenance of creative displays aligned with branding initiatives, creating disruption points throughout the store to engage consumers with our brands. • Actively interact with store personnel and consumers to provide in-depth product knowledge and insights, ensuring a positive brand experience. • Efficiently execute all sales programs and initiatives, including selling-in promotional programs, ensuring customer compliance, and achieving maximum brand potential. • Partner with Coca-Cola Merchandisers and BASN Field team to execute sales and merchandising plans effectively, maintain product inventory levels, minimize out-of-stocks, and uphold company merchandising standards. • Gather and report customer needs, problems, interests, and competitive activities, providing valuable input to internal teams for continuous improvement and increased customer goodwill. • Handle tasks such as checking date codes, managing account adherence to plan-o-grams, replacing decals or tags, and transporting, building and maintaining point of sale advertising and coupons for territory accounts as needed. • Utilize company-provided technology for real-time daily reporting, analyze reports, and leverage insights to drive success in-store.

Tennessee
$45K - $50K / year
Full TimeRemoteTeam 1,001-5,000Since 1997H1B Sponsor

• Collect and coordinate content from offices, providers, and field teams, including photos, videos, testimonials, and success stories. • Maintain content calendars and asset libraries. • Support development of social media, recruitment, and brand content. • Schedule and publish content across social media platforms. • Monitor engagement, comments, and messages. • Support employee-generated content and engagement campaigns. • Monitor and respond to online reviews using approved brand guidelines. • Escalate patient concerns and track resolution. • Support review generation and engagement initiatives. • Coordinate community events, sponsorships, health fairs, and grand openings. • Gather content and success stories from local events and partnerships. • Support employee recognition, provider spotlights, and culture-focused initiatives. • Track content performance, engagement metrics, and review trends. • Coordinate project timelines, approvals, and cross-functional requests. • Ensure brand standards and compliance requirements are maintained.

United States
Leidos logo

Marine Fleet Coordinator

Leidos

Leidos is an innovation company rapidly addressing the world’s most vexing challenges in national security and health.

General1 day ago
Full TimeRemoteTeam 10,001+Since 1969H1B Sponsor

• Advise Station Management regarding various marine oriented concerns. • Capability and willingness to mentor and provide advanced training to Station Staff. • Operates and maintains a fleet of an average of fifteen active small boats, including inflatable boats and outboard motors. • Operates vehicles and equipment to launch and recover the small boats via trailer. • Maintenance areas include, but are not limited to: inboard diesel, hydraulics, outboard motors, inflatable boats, and rigid hull inflatables, including proper inventory and tracking of spare parts. • Designs and implements training and oversight for station personnel in marine safety. • Leads the Ocean Search and Rescue (OSAR) team. • Conducts and documents monthly drills and training. • Maintains records of daily operations including vessel logs, situation reports, fuel usage, equipment maintenance, vessel launch/recovery, and turnover reports.

United States
$107.9K - $195.1K / year