Payment Integrity Analyst I

🔥 12 minutes ago

☕ Washington – Remote

☕ Washington – Remote

💵 $73k - $81k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

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Healthcare Management Administrators

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1986

⚕️ Healthcare Insurance

🤝 B2B

Healthcare Insurance • B2B

<Healthcare Management Administrators> is a service-oriented health plan administrator that designs and delivers high-quality, affordable self-funded health plans for employers. The company provides benefits administration, member portals, customer care, and access to a large provider network in the Pacific Northwest, helping employers manage claims, ID cards, provider search, and care navigation. HMA focuses on improving member outcomes and reducing employer health plan costs through proactive, people-first solutions and experienced plan management.

📋 Description

• Provide strong analytical, problem-solving and quality assurance skills to support efficient, accurate and timely execution of assigned payment integrity programs • Combine healthcare knowledge and technical skills using programs including QicLink and Excel and reporting from vendor systems to gather, assess, and perform detailed evaluations of data to: • Identify issues, recommend solutions, and manage situations to resolution. • Identify, evaluate and deliver new program improvements that increase cost containment results for HMA and its clients. • Track, manage, and report on daily program inventory for short-term prioritization and long-term strategic planning. • Evaluate existing business processes and policies and develop sustainable, measurable improvements. • Produce clear written documentation to ensure consistent and accurate service provision, such as Procedural Work Instructions or Job Aids for core practices and business requirements for program changes. • Collaborate effectively with internal teams including Appeals, Claims, Client Success, and Stop Loss to deliver an informed, coordinated experience for clients and members. • Interact and communicate effectively with payment integrity program vendors and government agencies to meet program expectations. • Maintain current in knowledge of claims processing, job-related systems, and associated government regulations, and pursue education and training relevant to Payment Analyst role.

🎯 Requirements

• High School Diploma required • ICD-10 & CPT experience required • 3-5+ year of claims processing experience within the insurance industry • 2+ year data entry experience • Intermediate Excel skills with the ability to build effective spreadsheets and manipulate data • Able to manage a complex daily queue and prioritize workload effectively • Skilled in identifying root causes of issues through detailed investigation and inquiry • Able to analyze impacts of potential actions or decisions to determine the optimal choice

🏖️ Benefits

• Seventeen (IC) days paid time off (individual contributors) • Twelve paid holidays • Two paid personal and one paid volunteer day • Company-subsidized medical, dental, vision, and prescription insurance • Company-paid disability, life, and AD&D insurances • Voluntary insurances • HSA and FSA pre-tax programs • 401(k)-retirement plan with company match • Annual $500 wellness incentive and a $600 wellness reimbursement • Remote work and continuing education reimbursements • Discount program • Parental leave • Up to $1,000 annual charitable giving match