Payment Integrity Specialist

Viva Health • Birmingham, AL

1d

About The Position

The Payment Integrity Specialist supports the organization’s payment integrity activities by researching claim payment issues, claim adjustments, and recoupments based on established policies, procedures, and vendor-identified findings. This entry-level role assists with claim adjustments, pricing validation, and recoupment activities by reviewing vendor findings, processing claim corrections, and coordinating internal follow-up in accordance with health plan policies, provider contracts, and regulatory requirements.

Requirements

• High School diploma or GED
• At least 1–3 years of healthcare claims processing experience, including adjustments or payment research
• Basic understanding of healthcare claims and reimbursement concepts
• Strong attention to detail and accuracy
• Ability to follow established procedures and meet productivity standards
• Effective written and verbal communication
• Strong organizational and time-management skills
• Ability to work independently within defined guidelines

Nice To Haves

• Associates degree or higher
• Experience in payment integrity, recovery auditing, or overpayment recovery
• Experience with health plan claims systems
• Knowledge of Centers for Medicare & Medicaid Services (CMS) guidelines and payer payment policies
• Working knowledge of claim edits, payment methodologies, and adjustment workflows

Responsibilities

• Receive, log, and track payment integrity findings from the vendor.
• Process claims adjustments, reversals, and recoupments in the claims processing system following documented procedures.
• Assist with pricing validation using established fee schedules and payment rules.
• Initiate recoupment transactions for confirmed overpayments following defined procedures.
• Ensure actions align with policies, contracts, and regulatory guidelines.
• Support research for payment integrity audit findings.
• Serve as a point of contact for payment integrity vendor activities related to adjustments, pricing discrepancies, and recoupments.

Benefits

• Comprehensive Health, Vision, and Dental Coverage
• 401(k) Savings Plan with company match and immediate vesting
• Paid Time Off (PTO)
• 9 Paid Holidays annually plus a Floating Holiday to use as you choose
• Tuition Assistance
• Flexible Spending Accounts
• Healthcare Reimbursement Account
• Paid Parental Leave
• Community Service Time Off
• Life Insurance and Disability Coverage
• Employee Wellness Program
• Training and Development Programs to develop new skills and reach career goals
• Employee Assistance Program

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED