Independence Blue Cross
Auditor, Payment Integrity (Chart Review - Remote)
What's your preference?
Job Description
- Req#: 6589
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Fully remote position, allowing for flexibility in your work environment
- Engage in meaningful work that enhances the health and well-being of communities
- Supportive and collaborative work environment with a focus on teamwork
- Competitive benefits package, including health insurance and retirement plans
What to Expect (Job Responsibilities):
- Perform medical chart reviews to ensure provider billing adherence to medical and claims payment policies
- Review inpatient charts to validate DRG assignment based on ICD-10-CM and ICD-10-PCS coding
- Ensure compliance with CMS guidelines, payer policies, and official coding rules
- Collaborate with Providers and Medical Directors to resolve audit disputes
- Initiate, verify, and reconcile claim adjustments while maintaining audit documentation
What is Required (Qualifications):
- Bachelor’s degree in a healthcare-related field or business-related discipline preferred
- Current credentials of CPC, RN, or RHIT/RHIA/CCS
- Strong knowledge of medical terminology and ICD-10-CM/PCS coding guidelines
- Inpatient Medical Chart Review experience is required
- Excellent communication skills: verbal and written
How to Stand Out (Preferred Qualifications):
- Understanding of Inpatient Prospective Payment System (IPPS), MSDRG, and regulatory requirements and/or Outpatient Prospective Payment System (OPPS)
- Analytical and detail-oriented with strong problem-solving skills
- Intermediate knowledge of MS Office: Excel, Word, Outlook
#HealthcareServices #RemoteWork #PaymentIntegrity #CareerOpportunity #CollaborativeEnvironment
"We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately. We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer."About the company
Independence Blue Cross is a health insurer based in Philadelphia, Pennsylvania, in the United States.
Notice
Talentify is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Talentify provides reasonable accommodations to qualified applicants with disabilities, including disabled veterans. Request assistance at accessibility@talentify.io or 407-000-0000.
Federal law requires every new hire to complete Form I-9 and present proof of identity and U.S. work eligibility.
An Automated Employment Decision Tool (AEDT) will score your job-related skills and responses. Bias-audit & data-use details: www.talentify.io/bias-audit-report. NYC applicants may request an alternative process or accommodation at aedt@talentify.io or 407-000-0000.