Senior Payment Integrity Analyst

🕒 6 dias atrás

🏄 California – Remoto

🏄 California – Remote

💵 $91.249 - $120.910 / ano

⏰ Tempo Integral

🟠 Sênior

🧐 Analista

👻 Score fantasma 1%

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IEHP

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 1995

🛡️ Seguros

💼 Consultoria

📦 Logística

💰 Grant em 2021-02

Insurance • Consulting • Logistics

IEHP é um plano de saúde dedicado a atender indivíduos e famílias de baixa renda nos condados de Riverside e San Bernardino. Eles oferecem uma variedade de programas, incluindo Medi-Cal, DualChoice e Covered California, fornecendo cobertura de saúde para residentes que, de outra forma, não teriam acesso aos serviços médicos necessários. Com foco na saúde holística e no bem-estar comunitário, a IEHP faz parcerias com médicos e instalações locais para garantir um cuidado abrangente para seus membros, apoiando-os com recursos em saúde mental, aulas de ginástica e educação para o bem-estar.

Descrição

• Provide lead-level analyst support to a team of Payment Integrity Analysts on daily operations of vendors and internal Payment Integrity programs • Provide quality assurance of junior analysts’ work and act on remediation plans to develop cost avoidance opportunities • Lead reporting and tracking of all vendor activity for daily and monthly management reporting • Partner with leaders and functional representatives to drive health plan financial performance through operational initiatives tied to payment integrity and provider claims accuracy • Make recommendations that inform decisions contributing to health plan strategy • Assess and assist with resolution of complex business challenges impacting cost containment and regulatory compliance • Incorporate IEHP’s Quality Program goals, including HEDIS, CAHPS, and NCQA Accreditation

🎯 Requisitos

• A minimum of five (5) years of experience in a combination of payment integrity, claims auditing, and/or medical coding required • Strong data analysis/queries experience • Experience with contract and Division of Financial Responsibility (DOFR) interpretation • Bachelor’s degree in business, health administration, or a related field from an accredited institution required • In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required; this experience is in addition to the minimum years listed in the Experience Requirements above • Certification in RHIA, RHIT, CCS, CPC, CIC or similar certification preferred • Strong knowledge and deep understanding of billing regulations (CMS, HIPAA), DRG, ICD-10, and CPT coding • Knowledge of medical coding (CPT, ICD-10, HCPCS) and health insurance contracts • Knowledge of the full claims lifecycle, including share of cost and coordination of benefits • Knowledge of Medicaid/Medi-Cal or Medicare regulatory frameworks • Knowledge of payment integrity concepts, including pre-pay audit, post-pay audit types, DRG validation, and coordination of benefits • Knowledge of data file layouts and system configurations to troubleshoot and coordinate remediation efforts with IT and vendors • Strong analytical skills with the ability to analyze large datasets and identify patterns • Strong proficiency in SQL, data visualization tools, and MS Excel • Strong written and verbal communication skills, including ability to synthesize complex information • Proven ability to analyze data to inform business decisions • Proven ability to work independently and apply business judgment in a highly regulated, cross-functional environment

🏖️ Benefícios

• Competitive salary • State of the art fitness center on-site • Medical Insurance with Dental and Vision • Life, short-term, and long-term disability options • Career advancement opportunities and professional development • Wellness programs that promote a healthy work-life balance • Flexible Spending Account – Health Care/Childcare • CalPERS retirement • 457(b) option with a contribution match • Paid life insurance for employees • Pet care insurance