Payment Integrity Specialist

6 days ago


Sioux Falls, South Dakota, United States Avera Full time

Job Summary

The Payment Integrity and Reimbursement Analyst plays a critical role in enhancing claim outcomes across existing and emerging product lines within the Network Services organization. This position is responsible for orchestrating collaborative efforts with cross-functional teams to devise and implement project strategies, mitigate risks, monitor progress, lead process optimization endeavors, and create transformative change.

Key Responsibilities

  • Oversee and manage the enhancement of claim outcomes across existing and emerging product lines
  • Collaborate with cross-functional teams to devise and implement project strategies
  • Mitigate risks and monitor progress
  • Lead process optimization endeavors and create transformative change
  • Develop a strategic roadmap to recover, eliminate, and prevent unnecessary medical-expense spending
  • Support the execution of a comprehensive claim accuracy program

Requirements

  • Bachelor's degree required; Master's degree preferred
  • Minimum of five years of progressive experience in the healthcare industry
  • Minimum of three years of applicable experience in Payment Integrity and Reimbursement
  • Minimum of five years of applicable experience with health insurance preferred

Work Schedule

Monday-Friday, Day Shift; 80 hours/2 weeks

Pay

The hourly range for this position is $43.50 per hour, dependent on experience.



  • Sioux Falls, South Dakota, United States Accuity Full time

    Job SummaryAccuity is seeking a highly skilled DRG Integrity Specialist to join our DRG Review Team. As a valued member of our team, you will perform a secondary level review of medical records and code assignment using knowledge of Accuity technology and client systems.Key ResponsibilitiesReview pre-bill cases simultaneously with a physician during each...


  • Sioux Falls, South Dakota, United States Push Pedal Pull Full time

    Job Title: Accounts Receivable SpecialistAt Push Pedal Pull, we are seeking a highly skilled and detail-oriented Accounts Receivable Specialist to join our team.Job Summary:The Accounts Receivable Specialist will be responsible for managing and ensuring the timely collection of outstanding invoices, resolving payment discrepancies, and maintaining accurate...


  • Sioux Falls, South Dakota, United States Automatic Building Controls, Inc. Full time

    Job SummaryAutomatic Building Controls, Inc. is seeking a highly detail-oriented and organized individual to fill the role of Accounts Receivable Specialist. This is a hourly-paid, 30-32 hours per week position located in Sioux Falls, SD.The successful candidate will be responsible for generating and sending out invoices and statements with accuracy,...


  • Sioux Falls, South Dakota, United States 1st Financial Bank USA Full time

    Job Title: Loan Servicing Specialist Job Summary: We are seeking a highly skilled Loan Servicing Specialist to join our team at 1st Financial Bank USA. As a Loan Servicing Specialist, you will be responsible for managing critical financial data, ensuring accuracy, and providing exceptional customer service. Key Responsibilities: * Input new loans into...


  • Sioux Falls, South Dakota, United States Avera Full time

    Award-Winning Health Care OrganizationAvera is a mission-driven organization that values teamwork, compassion, and career growth. As an Accounts Payable Specialist, you will play a crucial role in processing vendor bills and payments to ensure timely and accurate payments for goods and services received.What We Offer:Competitive PayFront-Loaded PTOOptions...


  • Sioux Falls, South Dakota, United States 1st Financial Bank USA Full time

    **Job Title:** Loan Servicing Specialist**Job Summary:**We are seeking a highly skilled Loan Servicing Specialist to join our team at 1st Financial Bank USA. As a Loan Servicing Specialist, you will be responsible for managing critical financial data, ensuring accuracy and efficiency in our banking operations.**Key Responsibilities:**Input data of new loans...


  • Sioux Falls, South Dakota, United States Ophthalmology Ltd Full time

    Job OpportunityWe are seeking a highly skilled Patient Account Specialist to join our team at Ophthalmology LTD.Job SummaryThe Patient Account Specialist will be responsible for providing billing assistance and general support to our business office. This includes verifying insurance coverage and network status for new patients and referrals, as well as...


  • Sioux Falls, South Dakota, United States Push Pedal Pull Full time

    Position OverviewJob Title: Receivables Management SpecialistLocation: RemoteWorking Hours: Standard business hours, Monday to FridayRole Summary:The Receivables Management Specialist plays a crucial role in overseeing the efficient collection of outstanding payments, addressing discrepancies in billing, and ensuring meticulous financial documentation. The...


  • Sioux Falls, South Dakota, United States Ophthalmology Ltd Full time

    Job Title: Patient Account SpecialistWe are seeking a highly organized and detail-oriented Patient Account Specialist to join our team at Ophthalmology Ltd. The successful candidate will be responsible for providing exceptional customer service and ensuring the smooth operation of our patient account management process.Key Responsibilities:Verify insurance...


  • Sioux Falls, South Dakota, United States 1st Financial Bank USA Full time

    Job Title: Loan Servicing SpecialistJob Summary:We are seeking a highly skilled Loan Servicing Specialist to join our team at Builder Finance Inc. The successful candidate will be responsible for managing critical financial data, ensuring accuracy and efficiency in all aspects of loan servicing.Key Responsibilities:Input data of new loans into banking...


  • Sioux Falls, South Dakota, United States Expansion Capital Group Full time

    Job DescriptionAt Expansion Capital Group, we are seeking a highly skilled Merchant Support Specialist to join our team. This role is responsible for investigating, negotiating, and collecting delinquent merchant accounts.Key Responsibilities:Review and apply the terms of our agreements with merchants to resolve compliance issues.Analyze complex financial...


  • Sioux Falls, South Dakota, United States 1st Financial Bank USA Full time

    **Job Summary**Builder Finance Inc. is seeking a skilled Financial Data Specialist to join our team. As a Financial Data Specialist, you will be responsible for critical financial data management, including inputting new loans into banking software, updating outstanding loans, and sending checks and wires to clients and title companies.**Key...


  • Sioux Falls, South Dakota, United States Ophthalmology Ltd Full time

    Job Title: Patient Account SpecialistWe are seeking a highly organized and detail-oriented Patient Account Specialist to join our team at Ophthalmology Ltd. The successful candidate will be responsible for providing billing assistance and general support to our business office.Key Responsibilities:Verify insurance coverage and network status for new patients...


  • Sioux Falls, South Dakota, United States Ophthalmology Ltd Full time

    Job OpportunityOphthalmology Ltd is seeking a highly skilled Patient Account Specialist to join our business office team.Key Responsibilities:Verify insurance coverage and network status for new patients and referralsUpdate patient information and resolve discrepancies in the payment processCollect payments from patients and provide excellent customer...


  • Sioux Falls, South Dakota, United States Diamond Mowers Full time

    Job Title: Account PayableAt Diamond Mowers, we are seeking a highly skilled and detail-oriented Account Payable professional to join our Accounting Team. As an Account Payable Specialist, you will play a critical role in ensuring the timely and accurate payment of vendors and suppliers, while maintaining compliance with company policies and procedures.Key...


  • Sioux Falls, South Dakota, United States Avera Full time

    Avera is seeking a skilled Admissions Specialist II to join our team. As a key member of our healthcare team, you will be responsible for registering patients in a timely and accurate manner, while performing all necessary procedures to establish accounts and medical record numbers.The ideal candidate will have a high school diploma or equivalent, and one to...


  • Sioux Falls, South Dakota, United States Avera Full time

    Award-Winning Healthcare OpportunityAvera is seeking a skilled Admissions Specialist II to join our team. As a key member of our healthcare team, you will be responsible for registering patients in a timely and accurate manner, verifying insurance coverage, and collecting patient co-payments and deductibles.Key Responsibilities:Register patients in a timely...


  • Sioux Falls, South Dakota, United States Insight Global Full time

    We are seeking a Technical Apprentice to join our team at Insight Global. This apprenticeship program is designed for recent graduates, veterans, and individuals with transferable skills looking to build a career in the security integration industry.Through this program, candidates gain foundational knowledge and on-the-job training, providing them with the...


  • Sioux Falls, South Dakota, United States Ophthalmology Ltd Full time

    Job OpportunityOphthalmology Ltd is seeking a skilled Patient Account Specialist to join our business office team. As a key member of our team, you will play a vital role in providing billing assistance and general support to our office.Responsibilities:Verify insurance coverage and network status for new patients and referralsUpdate information for existing...


  • Sioux Falls, South Dakota, United States Avera Full time

    Diagnostic Imaging SpecialistAward-winning healthcare provider Avera seeks a skilled Diagnostic Imaging Specialist to join its team. As a Diagnostic Imaging Specialist, you will be responsible for operating radiologic equipment to make clinical diagnostic images as directed by physicians. You may also perform invasive diagnostic procedures according to...