Payment Integrity Analytics Specialist

Job not on LinkedIn

🔥 2 minutes ago

🇺🇸 United States – Remote

💵 $56.8k - $96.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📉 Data Analyst

👻 Ghost score 0%

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PacificSource Health Plans

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1933

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

PacificSource Health Plans is a healthcare provider that offers a range of health insurance solutions, including plans for individuals, families, and employers. Their offerings include Medicare and Medicaid plans, dental coverage, and administrative services for small and large groups. Committed to member care, PacificSource emphasizes customer service and provides various resources for health management, including mental health support and wellness programs.

📋 Description

• Develop, maintain, and distribute payment integrity dashboards, reports, and performance scorecards • Track and monitor recoveries, cost avoidance, savings, inventory, and operational performance metrics • Analyze claims, provider, reimbursement, and audit data to identify payment integrity opportunities and emerging trends • Support fraud, waste, and abuse detection efforts through data analysis and reporting • Monitor vendor performance and validate reported recoveries, savings, and contractual performance measures • Develop recurring operational, financial, and executive reporting • Perform data validation, reconciliation, and quality assurance activities • Support audit targeting, provider outlier analysis, and recovery opportunity identification • Create ad hoc analyses and presentations to support leadership decision-making • Partner with Information Technology and enterprise data teams to improve reporting capabilities and data accessibility • Identify trends, risks, and opportunities and provide data-driven recommendations to leadership • Assist with budgeting, forecasting, and performance measurement activities related to payment integrity programs • Support regulatory reporting, audits, and documentation requests • Participate in departmental meetings, assigned projects, compliance initiatives, and operational initiatives • Perform other duties as assigned

🎯 Requirements

• Minimum of 3 years of healthcare analytics, claims analytics, payment integrity, finance analytics, reimbursement analysis, or closely related experience required • High school diploma or equivalent required • Bachelor's degree in business, finance, statistics, data analytics, healthcare administration, information systems, or related field preferred • Knowledge of healthcare claims processing and reimbursement methodologies • Knowledge of data analysis and reporting techniques • Knowledge of Microsoft Excel and reporting tools • Knowledge of statistical analysis and performance measurement concepts • SQL, Power BI, Tableau, or similar reporting platforms preferred • Medicare, Medicaid, Commercial, and Marketplace health plan operations preferred • Ability to follow privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information • Ability to read and comprehend both written and spoken English • Ability to communicate clearly and effectively • Ability to stoop and bend, sit and/or stand for extended periods, perform repetitive motions, and lift and carry files and business materials • Ability to meet department and company performance and attendance expectations

🏖️ Benefits

• Equal opportunity employer • Work-from-home arrangement indicated by location field (WFH: GA) • Ergonomically configured equipment • Travel approximately 5% of the time • Employment remains at-will