Payment Integrity Analyst – Data Mining, Savings Reporting

🕒 il y a 2 mois

🗽 New York, Vermont – Distant

🗽 New York – Remote 🍁 Vermont – Remote

💵 $69 383 - $92 279 / an

⏰ Temps Plein

🟡 Intermédiaire

🟠 Senior

🧐 Analyste

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MVP Health Care

Site WebLinkedInTous les Emplois

1001 - 5000 employés

Fondée en 1983

⚕️ Assurance santé

👥 B2C

🤝 B2B

Healthcare Insurance • B2C • B2B

MVP Health Care est un assureur de santé régional qui propose des plans Medicare Advantage, Medicaid, des plans individuels et familiaux, Child Health Plus, des plans essentiels, et une couverture de groupe parrainée par l'employeur. L'entreprise offre des plans complémentaires dentaires et visuels, des avantages en matière de prescription, des soins virtuels 24h/24 et 7j/7 via son portail en ligne Gia, des services aux membres pour la facturation et les réclamations, ainsi que des programmes de bien-être communautaire axés sur une couverture abordable et accessible à New York et dans les régions avoisinantes.

Description

• 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

🎯 Exigences

• 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.

🏖️ Avantages

• 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.