Senior Analyst, Payment Integrity

📋 Description

• SME for reimbursement policies and edits (internal and vendor).
• Respond to inquiries and disputes about policies and edits.
• Research coding rules; summarize policy language.
• Translate research into business requirements with partners.
• Ingest adverse claim outcomes; scope, size, prioritize items.
• Identify thematic opportunities via data mining and monitoring.

🎯 Requirements

• A bachelor's degree or 4+ years of commensurate experience.
• 3+ years in claims processing, coding, auditing, or health care claims ops.
• 3+ years experience in medical coding within payment integrity.
• Medical coding certification (AAPC CPC/COC or AHIMA CCS/RHIT/RHIA).
• Experience with reimbursement methodologies and provider contracts.
• 2+ years experience deriving business insights from datasets and solving problems.

🎁 Benefits

• Medical, dental, and vision benefits.
• 11 paid holidays.
• Paid sick time.
• Paid parental leave.
• 401(k) plan participation.
• Life and disability insurance.