Payment Integrity Specialist

🕒 4 days ago

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Council Capital

WebsiteLinkedInAll Job Openings

11 - 50 employees

Founded 2000

🏥 Healthcare

💸 Finance

Healthcare • Finance

Council Capital is a healthcare-focused private investment firm that partners with growth-stage, EBITDA-positive healthcare technology and healthcare services companies. They provide capital plus strategic, operational and network support through an experienced investment team, a Value Creation team, and a CEO Council of industry leaders (the CEO Council has personally invested more than $140M in the funds). Council Capital targets mission-driven, often founder-led or bootstrapped businesses with enterprise values typically up to $100M and emphasizes hands-on partnership to accelerate performance and growth.

📋 Description

• 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.

🎯 Requirements

• 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).

🏖️ Benefits

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