Talantix.io
Highmark•26.02.26
AI SCORE 8.5

Payment Integrity Clinician - Remote

$80K–$100K/year
RemoteHealthcare
ICD 10-CM Coding•HEDIS•Regulatory Compliance•Data Analysis•Quality Improvement

About the Role

We are seeking a dedicated Payment Integrity Clinician - Remote to join our dynamic healthcare team. As a Payment Integrity Clinician, you will play a crucial role in ensuring the accuracy and compliance of medical claims processing. This position offers the flexibility of remote work while contributing to the integrity of healthcare payments.

What You'll Do

  • Review and analyze medical claims to ensure adherence to regulatory compliance and coding standards.
  • Collaborate with healthcare providers to resolve discrepancies and improve claims accuracy.
  • Utilize data analysis techniques to identify trends and areas for improvement in claims processing.
  • Participate in quality improvement initiatives aimed at enhancing the payment integrity process.
  • Provide education and support to providers regarding coding and billing practices.

Requirements

  • Minimum of 3 years of experience in healthcare claims review or related field.
  • Strong knowledge of ICD 10-CM coding and HEDIS measures.
  • Experience with regulatory compliance and quality management in healthcare.
  • Excellent analytical skills and attention to detail.
  • Ability to work independently in a remote environment.

Nice to Have

  • Certification in medical coding (CPC, CCS, etc.)
  • Experience with automated dispensing systems and workflow management.
  • Familiarity with pharmacy operations and business strategy.

What We Offer

  • Competitive salary range based on experience.
  • Comprehensive health benefits including medical, dental, and vision.
  • Opportunities for professional development and career advancement.
  • Flexible working arrangements to promote work-life balance.
  • Access to company resources and training programs.
  • Employee wellness programs and initiatives supporting diversity and inclusion.
Why This Job8.5 of 10

This remote Payment Integrity Clinician role offers a competitive salary, comprehensive benefits, and the opportunity to work in a supportive healthcare environment.

Salary Range
Required
0/1
Optional
0/1
Bonus
0/1

Who Will Succeed Here

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Proficient in ICD 10-CM Coding with a strong understanding of HEDIS measures and their application in quality improvement, ensuring compliance with healthcare regulations.

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Self-motivated and detail-oriented, thriving in a remote work environment with the ability to manage multiple claims analysis projects independently while maintaining high accuracy.

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Analytical mindset with experience in data analysis tools and techniques, capable of identifying trends and discrepancies in claims data to enhance payment integrity and compliance.

Learning Resources

→ICD-10-CM Coding Guidelinesguide
→HEDIS Measures: A Comprehensive Overviewarticle
→Data Analysis for Healthcare Professionalscourse

Career Path

Payment Integrity Clinician - Remote(Now)→Quality Improvement Analyst(1-2 years)→Payment Integrity Manager(3-5 years)

Market Overview

Market Size 2024
$2.5B
Annual Growth
12.5%
AI Adoption in Healthcare Coding
45%
Investment in Health Tech
+30%
Labour Demand for Coding Specialists
+20%
Avg Salary for Payment Integrity Clinicians
$85K

Skills & Requirements

Required
ICD 10-CM CodingHEDISRegulatory Compliance
Growing in Demand
Clinical Data AnalyticsTelehealth ComplianceArtificial Intelligence in Healthcare
Declining
Paper-based DocumentationManual Coding Systems

Domain Trends

Increased Automation in Coding
By 2025, over 50% of coding processes will be automated, reducing the need for manual coding and increasing efficiency.
Regulatory Compliance Focus
75% of healthcare organizations are prioritizing regulatory compliance training as part of their workforce development.
Shift to Value-Based Care
80% of healthcare providers are transitioning towards value-based care models, emphasizing quality improvement and data-driven decision-making.

Industry News

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