Altais

Compensation

Full Description

About Altais: At Altais, we’re on a mission to improve the healthcare experience for everyone—starting with the people who deliver it. We believe physicians should spend more time with patients and less time on administrative tasks. Through smarter technology, purpose-built tools, and a team-based model of care, we help doctors do what they do best: care for people. Altais includes a network of physician-led organizations across California, including Brown & Toland Physicians, Altais Medical Group Riverside, and Family Care Specialists. Together, we’re building a stronger, more connected healthcare system. About the Role Are you looking to join a fast-growing, dynamic team? We’re a collaborative, purpose-driven group that’s passionate about transforming healthcare from the inside out. At Altais, we support one another, adapt quickly, and work with integrity as we build a better experience for physicians and their patients. As a Payment Integrity Coding and Operations Analyst within the Payment Integrity team, you will help us ensure honest claims are paid accurately, minimize losses, and protect those most vulnerable. You will be responsible for operationalizing payment integrity claim controls with a portion identifying providers who are not appropriately following protocol. You will review medical records and claims on both a pre and post pay basis and prepare claim payment recommendations based on your review. You will focus on Medical Record and Edit Review: Collaborate with the Payment Integrity team on healthcare fraud, waste, and abuse investigations Conduct provider claim review, prepare review summaries with recommendations and proper citations and resources Review medical records and claims on a pre and post pay basis for PI cases involving fraud, waste, or abuse Support investigation and clinical discussions with external parties including but not limited to: providers, regulators, law enforcement, etc. Apply industry, state, and federal regulations and guidelines Assess findings to detect patterns of fraud, waste and abuse Make accurate claim decisions based on policies, payment rules, and coding guidelines Payment Integrity Vendor Relationship Management: Subject matter expert in Payment Integrity vendor relationships Engage and align payment integrity vendors and all related internal teams and external vendor partners Growth & Optimization: Drive execution of initiatives related to payment integrity growth and optimization. Operationalize business and/regulatory requirements, including payment integrity process improvement and work for developing prospective claim editing while utilizing clinical coding and payment policies. The Skills, Experience & Education You Bring Bachelor’s degree or equivalent experience. 5+ years of experience in a position processing medical claims coding reviews 3+ years of experience conducting or managing comprehensive research to identify billing abnormalities, questionable billing practices, irregularities, and fraudulent or abusive billing activity 2+ years of experience working in a government, legal, law enforcement investigations, health care managed care, and/or health insurance environment Intermediate to advanced skills in Microsoft product suite Proven critical thinker Certified Professional Coder (CPC) The Base Salary for this position is $75,000 to $90,000/yr In addition, we provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs. Excellent medical, vision, and dental coverage 401k savings plan with a company match Flexible time off and 9 Paid Holidays You Share Our Mission & Values: Compassion We act with empathy and a deep respect for the challenges faced by physicians and their patients. Our work is driven by a genuine commitment to improving lives and ensuring that care is delivered with dignity, understanding, and humanity. Community We foster a culture of collaboration--with physicians, patients across the healthcare ecosystem, and among our teams. By building strong, trusted relationships, we create a unified community focused on advancing patient care and physician well-being. Leadership We lead with integrity and vision, setting the standard for excellence in physician support and healthcare innovation. Through collaboration and expertise, we empower others to lead, drive change, and shape the future of care. Excellence We are relentlessly focused, results-driven, and accountable for delivering measurable value to physicians and the patients they serve. Our high standards reflect our commitment to excellence, operational discipline, and continuous improvement. Agility We embrace change as a constant and respond swiftly to the evolving needs of the healthcare industry. With flexibility and forward-thinking, we adapt, innovate, and act decisively to keep physicians at the forefront. Altais values the contribution each Team Member brings to our organization. Final determination of a successful candidate’s starting pay will vary based on several factors, including, but not limited to education and experience within the job or the industry. The pay scale listed for this position is generally for candidates that meet the specified qualifications and requirements listed on this job description. Additional pay may be determined for those candidates that exceed these specified qualifications and requirements. We provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs. The anticipated pay range for this role is listed in our salary posting for transparency but may vary based on factors including the candidate’s qualifications, skills, and experience. Altais and its subsidiaries and affiliates are committed to protecting the privacy and security of the personal information you provide to us. Please refer to our ‘CPRA Privacy Notice for California Employees and Applicants’ to learn how we collect and process your personal information when you apply for a role with us. External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws. If you’re a big thinker, bold innovator, and fiercely motivated to drive change, consider joining our team. We are dedicated to creating exceptional healthcare experiences by building tools that cultivate the health and well-being of physicians, patients, and the clinical community.