Senior Analyst, Payment Integrity Disputes

📋 Description

• Contribute as subject matter expert for reimbursement policies and payment integrity disputes.
• Respond to internal and external inquiries and disputes regarding policies and edits.
• Research coding rules; summarize and input reimbursement policy language.
• Translate insights into business requirements; collaborate to implement changes.
• Ingest partner input on adverse claims; scope, prioritize and deliver solutions.
• Use data insights to identify opportunities and enhance processes.

🎯 Requirements

• Experience in Payment Integrity focused on Disputes and/or appeals
• 4+ years of experience in claims processing, coding, auditing or health care operations
• 3+ years experience in medical coding
• Medical coding certification through 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