Senior Payment Integrity Analyst

Job not on LinkedIn

🔥 0 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $91.2k - $120.9k / year

⏰ Full Time

🟠 Senior

🧐 Analyst

👻 Ghost score 1%

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IEHP

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1995

🛡️ Insurance

💼 Consulting

📦 Logistics

💰 Grant on 2021-02

Insurance • Consulting • Logistics

IEHP is a health plan dedicated to serving low-income individuals and families in Riverside and San Bernardino counties. They offer a variety of programs including Medi-Cal, DualChoice, and Covered California, providing healthcare coverage for residents who may not otherwise have access to necessary medical services. With a focus on holistic health and community wellness, IEHP partners with local doctors and facilities to ensure comprehensive care for their members, supporting them with resources in mental health, fitness classes, and wellness education.

📋 Description

• Provide lead-level analyst support to a team of Payment Integrity Analysts on daily operations of vendors and internal Payment Integrity programs • Provide quality assurance of junior analysts’ work and act on remediation plans to develop cost avoidance opportunities • Lead reporting and tracking of all vendor activity for daily and monthly management reporting • Partner with leaders and functional representatives to drive health plan financial performance through operational initiatives tied to payment integrity and provider claims accuracy • Make recommendations that inform decisions contributing to health plan strategy • Assess and assist with resolution of complex business challenges impacting cost containment and regulatory compliance • Incorporate IEHP’s Quality Program goals, including HEDIS, CAHPS, and NCQA Accreditation

🎯 Requirements

• A minimum of five (5) years of experience in a combination of payment integrity, claims auditing, and/or medical coding required • Strong data analysis/queries experience • Experience with contract and Division of Financial Responsibility (DOFR) interpretation • Bachelor’s degree in business, health administration, or a related field from an accredited institution required • In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required; this experience is in addition to the minimum years listed in the Experience Requirements above • Certification in RHIA, RHIT, CCS, CPC, CIC or similar certification preferred • Strong knowledge and deep understanding of billing regulations (CMS, HIPAA), DRG, ICD-10, and CPT coding • Knowledge of medical coding (CPT, ICD-10, HCPCS) and health insurance contracts • Knowledge of the full claims lifecycle, including share of cost and coordination of benefits • Knowledge of Medicaid/Medi-Cal or Medicare regulatory frameworks • Knowledge of payment integrity concepts, including pre-pay audit, post-pay audit types, DRG validation, and coordination of benefits • Knowledge of data file layouts and system configurations to troubleshoot and coordinate remediation efforts with IT and vendors • Strong analytical skills with the ability to analyze large datasets and identify patterns • Strong proficiency in SQL, data visualization tools, and MS Excel • Strong written and verbal communication skills, including ability to synthesize complex information • Proven ability to analyze data to inform business decisions • Proven ability to work independently and apply business judgment in a highly regulated, cross-functional environment

🏖️ Benefits

• Competitive salary • State of the art fitness center on-site • Medical Insurance with Dental and Vision • Life, short-term, and long-term disability options • Career advancement opportunities and professional development • Wellness programs that promote a healthy work-life balance • Flexible Spending Account – Health Care/Childcare • CalPERS retirement • 457(b) option with a contribution match • Paid life insurance for employees • Pet care insurance