Research Analyst – Medical Management

🕒 Yesterday

🏄 California, Oregon, +1 more states – Remote

🏄 California – Remote 🌲 Oregon – Remote ☕ Washington – Remote

💵 $29.1k - $57.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔬 Research Analyst

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Providence

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1856

⚕️ Healthcare Insurance

Healthcare Insurance

Providence is a not-for-profit health system committed to providing a wide range of medical services, including primary care, urgent care, pediatrics, maternity care, cancer treatment, and specialized services like neurosurgery and orthopedics. They offer both in-person and virtual care through clinics and a mobile app, ensuring patients can access healthcare conveniently. With a mission rooted in compassion, dignity, and justice, Providence emphasizes serving those who are vulnerable and strives for excellence in healthcare delivery. They are involved in research and innovation, including genomic profiling and clinical trials to improve patient outcomes.

📋 Description

• Identifying, developing, and implementing solutions to improve the accuracy and integrity of claims payments across the Plan. • Focusing on preventing and reducing unnecessary spending by scoping PI initiatives, analyzing claims data, and developing a thorough implementation assessment plan. • Collaborating with internal and external stakeholders to optimize the payment processes. • Leveraging a deep understanding of Providence Health Plan infrastructure, claims edit and processing platforms, Plan policy, regulatory/compliance, benefit, and contracting functions to synthesize meaningful and actionable PI initiative recommendations.

🎯 Requirements

• Bachelor's Degree, or 3 years equivalent experience. • 3 years experience with performance improvement/organizational change tools. • 3 years experience working with large data sets and analytics teams. • 3 years claims processing experience within the health insurance industry. • Experience with reimbursement methodologies, including the Centers for Medicare & Medicaid Services (CMS), provider contracts, and medical coding practices. • Healthcare experience in project coordination encompassing operations analysis, outcomes measurement methodology, data management and quality improvement process design.

🏖️ Benefits

• Health care benefits (medical, dental, vision) • 401(k) Savings Plan with employer matching • Life insurance • Disability insurance • Paid parental leave • Vacations • Holidays • Health issues time off • Voluntary benefits • Well-being resources