Payment Validation Specialist

The Payment Validation Analyst evaluates claim issues due to billing errors, coding edits, rejections, denials, and payment variances. This position is responsible for updating payment system with rate changes and performing data validation.

ESSENTIAL RESPONSIBILITIES:

• Updates payment system with rate changes and performs data validation to ensure billing integrity.
• Performs data analysis on claim payments and troubleshoots discrepancies.
• Assists with the resolution of payment discrepancies.
• Responds to provider inquiries regarding claim submission and status.
• Ability to analyze and challenge health care claim adjudication results.
• Performs other duties as required.

JOB SPECIFICATIONS:

• Associate or Bachelor’s degree or equivalent work experience.
• Understanding of Health care claims adjudication processes, logic, and data.
• Understanding of Health industry diagnosis, procedure and revenue codes and their application.
• Proficient with Microsoft Excel, Access and SQL or other database software.
• Demonstrated analytical, problem solving and critical thinking skills.
• Excellent communication and presentation skills.
• Highly self-motivated and able to work well in a fast-paced environment.
• Proof of Covid vaccine

EEO Statement

Element Care is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, sex, color, religion, national origin, sexual orientation, protected veteran status, or on the basis of disability.

Element Care is committed to valuing diversity and contributing to an inclusive working environment