Payment Integrity Analyst (Inpatient)

CoverSelf empowers payers and providers with a truly NEXT-GEN cloud-native, holistic & customizable platform preventing and adapting to the ever-evolving claims & payment inaccuracies. Reduce complexity and administrative costs with a unified healthcare dedicated platform. We are backed by top VCs.

We foster an environment of employee empowerment whereby each team member is given the freedom to demonstrate excellence through their skills, character, and background. Our team members are motivated individuals who help each other do remarkable things every day.

About the role:

We're looking for someone who is expertise in preparing rule logic for the inpatient domain and must have strong knowledge of DRG, ICD-10-PCS and clinical criteria of diagnosis.

Responsibilities:

• Identify, Interpret, develop, and implement new concepts that will recognize incorrect payments. Concepts are developed based on industry experience, regulatory research, and ability to analyze medical claim data to discover incorrect claims.


• Owning medical policies end to end.


• Development of ICD-10 CM, PCS Coding guidelines, AHA coding clinics, UHDDS guidelines, Medicare/Medicare rules.


• Identifies data trends and suggests resolutions and opportunities for process improvement.


• Updating and developing new and current audit recovery reports (OIG audit trends), developing and running custom queries.


• 
  Researching reimbursement regulations for claim payment compliance reviews and documentation to support current audit findings

Requirements:

• CIC or CCS certified


• Solid knowledge and understanding of clinical criteria documentation requirements to successfully substantiate code assignments.


• Demonstrated understanding of the APR-DRG, MS-DRG, ICD-10, clinical criteria, and clinical review judgement.


• Demonstrated proficiency in medical record analysis and ICD-10-CM and PCS coding methodologies.


• Well updated with AHA coding clinics, UHDDS guidelines.


• Solid knowledge and understanding coding guidelines and medical code sets like PCS, MDC, DRG, CPT, ICD, indicator files etc, coding conventions and rules.


• Demonstrated experience in medical review, chart audits, and quality improvement processes.


• Experience with data collection, analysis, and interpretation.


• Well updated with claim forms, denial management for inpatient.
  


• Desire to grow professionally, develop new skills and willingness to work outside of comfort zone.


• Ability to work in a fast-paced and dynamic work environment.


• Excellent communication (Verbal & Written) and strong interpersonal skills


• Good analytical skills and effective stakeholder management.


• Exceptional interpersonal skills and demonstrated leadership abilities


• Entrepreneurial at heart and likes to take ownership

Experience: CIC or CCS certified with 5+ years’ experience in payment integrity or revenue integrity or IP denials Management, Minimum 4+ years of experience in Inpatient claim audit or Reimbursement IP policies

Work Location: Bangalore

Work Mode: WFO

Benefits: Best in the Industry Compensation, Friendly & Flexible Leave Policy, Health Benefits, Certifications & Courses Reimbursements, Chance to be part of rapidly growing start-up & the next success story, and many more.

Additional Information:

At CoverSelf, we are creating a global workplace that enables everyone to find their true potential, purpose, and passion irrespective of their background, gender, race, sexual orientation, religion and ethnicity. We are committed to providing equal opportunity for all and believe that diversity in the workplace creates a more vibrant, richer work environment that advances the goals of our employees, communities and the business.