We’re a Good Family to Know:

Preferred Family Healthcare (PFH) is a community-based healthcare organization that offers a full array of integrated services, serving more than 100,000 individuals each year in nearly 100 locations throughout Missouri, Oklahoma, Kansas and Illinois.

Our greatest reward has been the opportunity to serve families and communities in need for the past 40 years. At PFH, our future is brighter than ever! With changes in leadership, focused priorities and strong core values, PFH remains a “Good Family to Know!”

Your role at PFH:

As an Compliance Claim Integrity Specialist, you are responsible for supporting the Compliance Office in its role of conducting investigative analysis of reimbursement and billing processes in response to the discovery of potential overpayments involving the Federal health care programs. You will:

• Conduct investigations of billing, coding and documentation concerns identified through the Compliance Disclosure Program.
• Analyze and investigate payor refund requests and provide recommendations on response (e.g. submit appeal, issue refund).
• Document investigation process, maintaining a high-level of detail and composes written reports that include determinations and corrective action.
• Identification and reporting of abnormal billing patterns and other indicators (e.g. services not rendered, up-coding, unbundling, etc.) of suspected fraud and abuse to the Lead Compliance Audit Coordinator.
• Work closely with members of the Revenue Cycle Department to ensure timely repayment of any identified overpayments.
• Present findings and recommendations in a professional and knowledgeable manner.

We think you’d be great for this role if you have:

• Associates degree in Health Information Management, preferred
• At least one of the following credentials (RHIA, RHIT, CCS, CPC, COC), strongly preferred
• 1 to 3 years of medical billing experience with preferred education.
• 5 years of industry experience, including 1-3 years of medical billing experience without preferred education

You’ll love being a part of our family because:

Our eligible associates enjoy some of the following PFH Perks:

• Comprehensive medical, dental, vision, life insurance and disability plan options
• Competitive 401(k) Retirement Savings Plan – up to 5% match!
• Company paid basic life insurance
• Paid Time Off Program for vacation, holiday and sick time
• Emergency Medical Leave Program
• Flexible Spending Accounts – healthcare and dependent child-care
• Health & Wellness Program
• Employee Assistance Program (EAP)
• Employee Discount Program
• Mileage Reimbursement
• License/Certification Reimbursement

Our human resources team wants to let you know what’s required:

Employment is conditional upon the receipt of appropriate background checks. Upon offer of employment, you must grant permission for Preferred Family Healthcare to verify accuracy, legitimacy, and results in regards to the following conditions of employment:

• Background check that includes criminal history and abuse/ neglect.
• Motor vehicle driving record check.
• Education and license/certification verification (if applicable).
• Employment and/or personal reference checks.