Payment Integrity Specialist

TL;DR

Payment Integrity Specialist (Healthcare Claims): Managing complex healthcare claim negotiations and ensuring compliance with federal regulations with an accent on No Surprise Act Negotiations, IDR appeals, and provider settlements. Focus on reviewing itemized bills with OCR and spreadsheet preparation, negotiating settlements, and releasing claims in TPA systems.

Location: Remote, United States

Compensation: $23-$26 per hour

Company

Personalized health platform serving employers, health plans, and health systems with data-driven solutions that reduce costs and improve health outcomes.

What you will do

• Complete No Surprise Act Negotiations and defend employer groups in the NSA and IDR appeal process.
• Review itemized bills and prepare them for physician review including OCR and spreadsheet entry/formatting.
• Prepare and negotiate settlements with providers and follow up on unsigned settlements.
• Release claims in various TPA systems.
• Assist with SCA negotiations.

Requirements

• At least 5 years of experience in TPA, Payment Integrity, Revenue Cycle management, and/or coding.
• High school diploma.
• Knowledge of medical terminology and medical billing terminology.
• Experience with Excel, OCR, and strong software/technical proficiency.
• Attention to detail, organizational efficiency, ability to manage stakeholders/deadlines, strong negotiation/dispute resolution skills, self-starter.

Culture & Benefits

• Competitive base salary and full benefits package starting day one, including comprehensive medical/dental, PTO, mental health support, retirement planning, financial protection.
• Professional development with clear career progression and learning budgets.
• Mission-driven inclusive culture celebrating diversity, innovation, and collaboration for real health impact.