Payment Integrity Analyst

Job not on LinkedIn

🔥 0 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $77.4k - $96.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

InnovAge

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

InnovAge is a provider of the Program of All-inclusive Care for the Elderly (PACE) that helps frail seniors remain independent and age in their own homes with dignity. As the largest PACE provider by participants served, InnovAge delivers comprehensive, coordinated services including primary care, nursing, behavioral health, therapies, transportation and care coordination to support seniors' medical and daily living needs.

📋 Description

• Provide quality and operational support for PACE program administration • Support claims auditing, testing, data analysis, issue resolution, systems support, and process improvement initiatives • Support internal teams, external partners, and stakeholders across claims processing, provider data management, and claims customer services • Analyze, troubleshoot, and resolve issues related to claims, provider networks, and benefits • Liaise between internal departments and external vendors or PACE program partners • Monitor claims quality and integrity and resolve discrepancies with IT or other teams • Maintain documentation of workflows, business rules, and process changes • Coordinate implementation of newly covered services and system upgrades • Create and distribute reports and provide analyses for business decisions and regulatory compliance • Assist with system-update and enhancement testing, including UAT • Identify process improvements and participate in initiatives enhancing operational efficiency and member experience • Stay updated on regulatory and industry changes affecting PACE operations

🎯 Requirements

• Bachelor’s degree in healthcare administration, business, or related field, or equivalent work experience • 4+ years of experience in a claims healthcare environment or health insurance • Strong analytical and problem-solving skills • Proficiency in Microsoft Excel, data tools, and reporting software • Excellent written and verbal communication skills • Ability to work independently and collaboratively in a fast-paced environment • Experience with payer health plan systems such as Plexis, Facets, QNXT, Epic Tapestry, or similar preferred • Knowledge of HIPAA, Medicare, Medicaid, or ACA regulations preferred • SQL or other data query skills a plus • Florida applicants must complete a background screening through the Florida Care Provider Background Screening Clearinghouse

🏖️ Benefits

• Medical, dental, and vision insurance • Short- and long-term disability insurance • Life insurance and AD&D • Supplemental life insurance • Flexible spending accounts • 401(k) savings/plan with company match • Paid time off • Company-paid holidays • Equal opportunity and affirmative action workplace • Diverse and inclusive workplace • Patient-centered care model • Work alongside talented, respectful, and passionate colleagues