Payment Integrity Analyst – Data Mining, Savings Reporting

🕒 vor 2 Monaten

🗽 New York, Vermont – Remote

🗽 New York – Remote 🍁 Vermont – Remote

💵 $69.383 - $92.279 / Jahr

⏰ Vollzeit

🟡 Mittelstufe

🟠 Senior

🧐 Analyst

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MVP Health Care

WebsiteLinkedInAlle Stellen

1001 - 5000 Mitarbeiter

Gegründet 1983

⚕️ Krankenversicherung

👥 B2C

🤝 B2B

Healthcare Insurance • B2C • B2B

MVP Health Care ist ein regionaler Krankenversicherer, der Medicare Advantage, Medicaid, individuelle und Familienversicherungen, Child Health Plus, Essential Plans und arbeitgeberfinanzierte Gruppenversicherungen anbietet. Das Unternehmen bietet zusätzliche Zahn- und Sehpläne, Rezeptvorteile, 24/7-Online-Betreuung über das Gia-Portal, Mitgliederdienste für Abrechnungen und Ansprüche sowie Gemeinschaftsgesundheitsprogramme, die auf erschwingliche und zugängliche Versicherungen in New York und den angrenzenden Regionen ausgerichtet sind.

Beschreibung

• 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

🎯 Anforderungen

• 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.

🏖️ Vorteile

• 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.