Payment Integrity Analyst

🕒 Ontem

🌲 Oregon, Washington – Remoto

🌲 Oregon – Remote ☕ Washington – Remote

💵 $32 - $39 / hora

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

🧐 Analista

🦅 Patrocina Visto H1B

Esta empresa já patrocinou vistos H1B no passado.

👻 Score fantasma 0%

O que significa: quão provável esta vaga está aberta sem contratação ativa.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Como pontuamos: tempo em aberto, republicações, vagas abertas vs tamanho do time, rapidez para fechar vagas, e se o salário está divulgado.Observação: é uma estimativa de dados públicos, não um julgamento da empresa. Vagas reais podem ter pontuação alta, então use como uma dica, não como um fato.

Candidatar-se

Encontrar Vagas Remotas Similares

Configurar Alerta de Email para Novas Vagas

📊 Verifique sua pontuação de currículo para esta vaga

Melhore suas chances de conseguir uma entrevista verificando sua pontuação de currículo antes de se candidatar.

Enviar Currículo

CareOregon

SiteLinkedInTodas as Vagas

501 - 1000 funcionários

Fundada em 1994

🏥 Saúde

📦 Logística

🛡️ Seguros

Healthcare • Logistics • Insurance

A CareOregon é um plano de saúde focado na comunidade que fornece serviços coordenados de saúde física, comportamental, dental e de apoio social para membros do Oregon Health Plan, atendendo mais de 500. 000 pessoas. A organização opera portais para fornecedores e membros, oferece coordenação de cuidados, telemedicina, serviços de idiomas e tribais, doações comunitárias e alcance, além de programas que abordam os determinantes sociais de saúde, como habitação, nutrição e transporte.

Descrição

• Execute claims investigation and recovery strategies • Analyze claims data to identify cost containment opportunities and ensure proper claims payments • Conduct simple to complex claims audits • Review and analyze new audit concepts and recommend recoveries • Partner with vendors on recovery audits and investigations • Coordinate with Clinical, Contracting, Configuration, Finance, Claims, and Provider Relations teams • Implement Payment Integrity initiatives directed by the Payment Integrity Manager and/or Director • Review CMS/RAC topics for viability against CareOregon paid claims • Review vendor overpayment suggestions for accuracy, scope adherence, recovery activities, concept submissions, and claim sample approval • Discuss system corrections and overpayment recommendations with claims payment vendors and internal departments • Identify and document overpayment root causes and remediation recommendations • Research claims payments using OHA tools, Medicare billing guidelines, CareOregon policies and procedures, and other resources • Enter and update recovery information in claims systems, call tracks, and payment integrity tools • Prepare provider overpayment notification letters with reconciliation backup documentation • Meet payment integrity, productivity, quality, and monthly savings goals • Communicate with internal and external customers about recovery, claims payments, remittances, and recovery processes • Handle provider calls related to overpayment requests and activities • Research and resolve payment disputes with timely follow-up • Maintain knowledge of regulations relevant to payment recovery and claims processing • Escalate complex issues to the Payment Integrity Manager • Perform claims adjustments identified in audits when needed • Support User Acceptance Testing for large-scale testing projects when needed

🎯 Requisitos

• Minimum 3 years’ experience in roles using Medicare and/or Medicaid claims management systems • Minimum 1 year’ experience performing advanced claims adjustments • 2 years of QNXT experience preferred • Certification experience performing statistical claims analysis in a managed care or health care setting preferred • Clinical coding certification(s), such as CPC, CCS, CMC, or CCA, preferred • Experience with payment integrity programs and/or vendors preferred • Experience with SQL Server Reporting, business intelligence tools such as Tableau, and data frameworks preferred • Working knowledge of claims coding requirements and payment methodologies, including PPS and Medicare Fee Schedules • Knowledge of medical terminology • Knowledge and skill in using claims management systems, editing software, and medical coding • Understanding of complex claims processing and payment integrity/payment policy initiatives, including manual pricing, COB, and adjustments • Ability to learn state and federal claims and payment integrity regulations • Ability to use computer programs commonly used for health plan operations • Statistical, analytical, and problem-solving skills • Strong organization and detail-orientation skills • Ability to prioritize work and work independently • Ability to work well under pressure in a complex and rapidly changing environment • Good spoken and written communication skills • Ability to present complex information to groups • Excellent interpersonal skills • Ability to work effectively and professionally with diverse individuals and groups • Advanced Excel skill helpful • Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day • Ability to hear and speak clearly for at least 3–6 hours/day

🏖️ Benefícios

• Bonus - SIP Target, 5% Annual • Medical insurance • Dental insurance • Vision insurance • Life insurance • AD&D insurance • Disability insurance • Health savings account • Flexible spending account(s) • Lifestyle spending account • Employee assistance program • Wellness program • Discounts • Supplemental benefits including voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, and 529 College Savings • Retirement plan with employer contributions • PTO • Paid State Sick Time • Paid holidays • Volunteer time • Jury duty leave • Bereavement leave • 401(k) contributions for non-benefits-eligible employees