Payment Integrity Clinician - (Remote)

Are you a highly skilled and motivated clinician looking for a new and exciting remote opportunity? Look no further! Highmark Health is seeking a talented Payment Integrity Clinician to join our growing team. In this role, you will play a crucial role in ensuring the accuracy and compliance of payment processes for our organization. We are seeking a detail-oriented individual with a strong background in healthcare and a passion for promoting quality and cost-effective care. If you are ready to make a positive impact in the healthcare industry while working in a flexible and remote environment, we encourage you to apply for this position. Conduct thorough reviews and analysis of payment data to identify any discrepancies or potential fraudulent activity. Collaborate with cross-functional teams to develop and implement effective payment integrity strategies and processes. Utilize advanced clinical knowledge to evaluate the medical necessity and appropriateness of services and treatments. Ensure compliance with all relevant regulations and industry standards related to payment processes. Monitor and report on payment trends and patterns to identify potential areas for improvement or risk. Review and resolve claim disputes and appeals, utilizing strong communication and negotiation skills. Develop and maintain strong relationships with internal and external stakeholders, including healthcare providers and vendors. Stay up-to-date with industry changes and best practices related to payment integrity and make recommendations for process improvements. Conduct trainings and presentations for colleagues and clients to promote understanding and compliance with payment integrity processes. Maintain accurate and detailed documentation of all payment integrity activities and outcomes. Participate in audits and quality assurance processes to ensure accuracy and integrity of payment processes. Adhere to strict confidentiality and data privacy guidelines to protect sensitive information. Consistently meet or exceed performance metrics related to payment integrity processes. Embrace a culture of continuous learning and improvement to stay current with industry trends and advancements in technology. Represent the organization with professionalism and promote a positive image in all interactions with clients and stakeholders. Highmark Health is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate based upon race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.