Recovery Analysts (Payment Integrity experience required)

Do you have a deep understanding of payment integrity concepts, strong organizational skills, and the ability to identify and validate medical insurance claim overpayments through data mining efforts? ​

You may be ideal for this position if: - Minimum 2 years of experience in health insurance payment integrity - Knowledge of claim coding, including CPT, HCPCS, ICD-10 codes, and modifiers. - Knowledge of claim reimbursement methodologies such as: DRG, OPPS, APC, NCCI Edits, MUE’s, and determining patient liability amounts. - Demonstrated ability to learn and navigate multiple payer systems and applications. - Intermediate Excel skills

More about the position - Validating claim overpayments based on reimbursement methodology, claim coding details, and the audit’s edit parameters - Compiling sample claims and supporting documentation for Client review and approval - Maintaining a library that includes instructions for validating specific audit concepts - Assisting in review of provider appeals - Identify process and audit concept improvements to ensure the best outcomes

Why choose ClarisHealth? - ClarisHealth unites data and people through innovative technology. - Remote-first flexible working environment - OUR AMAZING BENEFITS - Health insurance, including $0 premium HDHP and $0 deductible PPO options. FIRST-DAY COVERAGE! - Generous Paid Time Off: 4 weeks PTO, 1 week Wellness Time, 2 days volunteer time off, 9 holidays, 2 floating holidays - 401(k) with matching, immediate vesting - “Got Your Back” environment - We work hard, but we know how to take time and enjoy life

For more information on our culture and employment opportunities, please visit us at https://www.clarishealth.com/careers/. #GYB

Help develop the industry-leading solution for the healthcare payer market. Join our team at ClarisHealth in challenging the traditional paper-based, time- and labor-intensive audit and data mining methods and make an impact on the evolution of claims payment recovery.

ClarisHealth answers the health plan industry’s siloed solutions and traditional models for identification and overpayment recovery services. Founded in 2013, we provide health plans and payers with total visibility into payment integrity operations through our advanced cost containment technology Pareo®. Pareo enables health plans to maximize avoidance and recoveries at the most optimized cost for a 10x return on their software investment. Currently, nearly 33 million lives are served by our total payment integrity platform.

ClarisHealth embraces a supportive working culture of creativity and innovation internally termed “Got Your Back.” We live out this #GYB spirit every day by leading with Compassion, Communicating with transparency, and committing to improving our Community.

Applicants must be currently authorized to work in the United States on a full-time basis. ClarisHealth is not able to sponsor applicants for work visas.

ClarisHealth is an Equal Opportunity Employer. Anyone needing accommodation to complete the interview process should notify the Director, People & Management.

EOE, including Disability/Veterans/