Payment Integrity Analyst – Data Mining, Savings Reporting

🕒 Abril 1

🗽 New York, Vermont – Remoto

🗽 New York – Remote 🍁 Vermont – Remote

💵 $69.383 - $92.279 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

🧐 Analista

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MVP Health Care

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 1983

⚕️ Seguro de Saúde

👥 B2C

🤝 B2B

Healthcare Insurance • B2C • B2B

A MVP Health Care é uma seguradora regional de saúde que oferece planos Medicare Advantage, Medicaid, planos individuais e familiares, Child Health Plus, Planos Essenciais e cobertura para grupos patrocinada por empregadores. A empresa fornece planos suplementares de saúde dental e oftalmológica, benefícios de medicamentos prescritos, atendimento virtual 24/7 através de seu portal online Gia, serviços de atendimento ao membro para faturamento e reivindicações, e programas de bem-estar comunitário focados em cobertura acessível e acessível em Nova Iorque e regiões próximas.

Descrição

• Use advanced data mining and analytical techniques to identify improper payments, uncover cost savings opportunities, and support accurate, compliant claims payment across our health plan and report on financial trends • Build, maintain, and enhance data pipelines that support payment integrity and savings analysis initiatives • Analyze healthcare claims data to identify improper payments, wasteful spend, and cost reduction opportunities • Perform deep-dive statistical analysis, predictive modeling, and experimental design to inform business strategies and operational improvement • Conduct detailed reviews of claims history, provider files, and medical reviews to identify billing irregularities and financial trends • Collaborate with cross-functional partners to quantify and report savings generated by payment integrity activities • Develop and deliver actionable insights and evidence-backed referrals that reduce health insurance costs • Prepare and present savings reports, trending analyses, and recommendations to stakeholders • Identify and resolve data quality issues, including discrepancies or missing data • Ensure all analysis and reporting complies with regulatory requirements and internal policies

🎯 Requisitos

• Bachelor’s degree in healthcare administration, business, data science, or a related field or 5 years of equivalent experience in healthcare billing, claims adjudication, payment integrity operations, or healthcare reimbursement analytics • 3+ years of experience working with healthcare data analysis, group health business, or provider practice preferred • Strong experience analyzing large healthcare datasets using SQL or modern data tools (e.g., Snowflake, dbt, Looker, Python) • Experience with claims, payment integrity, or Medical Economics, especially in Medicare Advantage and/or New York Medicaid is a plus • Advanced analytical skills with the ability to interpret complex data and derive meaningful insights • Detail-oriented with a high level of precision and accuracy in handling critical data • Strong critical thinking, problem-solving, and communication skills (oral and written) • Ability to work independently and collaboratively in a fast-paced, high-growth environment • Skilled at preparing clear, actionable documentation and executive-level summaries • Intermediate knowledge of local, state, and federal laws and regulations pertaining to health insurance is a plus.

🏖️ Benefícios

• Growth opportunities to uplevel your career • A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team • Competitive compensation and comprehensive benefits focused on well-being • An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work For in the NY Capital District, one of the Best Companies to Work For in New York, and an Inclusive Workplace.