Payment Integrity Specialist

🕒 Julho 29

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Council Capital

SiteLinkedInTodas as Vagas

11 - 50 funcionários

Fundada em 2000

🏥 Saúde

💸 Finanças

Healthcare • Finance

A Council Capital é uma firma de investimento privado focada em saúde que colabora com empresas de tecnologia em saúde e serviços de saúde em fase de crescimento que são positivas em EBITDA. Eles fornecem capital e suporte estratégico, operacional e em rede por meio de uma equipe de investimento experiente, uma equipe de Criação de Valor e um Conselho de CEOs de líderes do setor (o Conselho de CEOs já investiu pessoalmente mais de US$ 140 milhões nos fundos). A Council Capital foca em empresas orientadas por missão, muitas vezes lideradas por fundadores ou autofinanciadas, com valores empresariais tipicamente de até US$ 100 milhões, enfatizando a parceria prática para acelerar o desempenho e o crescimento.

Descrição

• Audit payer claims across multiple lines of business (commercial, FEP, Medicaid, Medicare) to identify improper payments and recovery opportunities. • Analyze claims data in depth to determine root causes of improper payments and build defensible audit findings. • Meet or exceed a monthly dollars-identified goal once assigned to a client (goal is set per client and audit type; expect a ramp during onboarding). • Maintain a high quality standard on all identified dollars, minimizing false positives so findings hold up under client review. • Generate new audit concepts and recovery ideas from patterns you see in the data (target of at least one new concept per month). • Support key stakeholders with on-time client deliverables, including audit results and documentation. • Apply payment integrity and claims-processing knowledge across different payers and claim systems as engagements shift. • Contribute to the team's shared knowledge (trends, methods, and audit playbooks) as our capabilities grow.

🎯 Requisitos

• 2+ years of experience at a payer or a payment integrity / audit vendor • Hands-on experience with claims processing and payment integrity auditing • Exposure across multiple lines of business (commercial, FEP, Medicaid, Medicare); breadth is preferred over depth in a single line. • Strong analytical instincts: you find the significant problem in the data and work it to root cause. • Comfort with Excel and general software; you learn new claims systems quickly (system-specific training is provided per client). • A track record of hitting metric-driven, time-bound goals and staying composed under a monthly target. • High integrity and sound judgment; you make the call on findings and stand behind them. • Self-direction and ownership; you do not need to be managed through your queue. • Authorized to work in the U.S. and U.S.-based (this role handles PHI and cannot be performed offshore).

🏖️ Benefícios

• Health insurance • Paid time off • Flexible work arrangements • Professional development opportunities