Payment Integrity Analyst

This is a fully remote position, open to applicants in Florida.

📋 Description

• Deliver quality and operational support for the administration of the PACE program.

• Assist with claims auditing, testing, data analysis, issue resolution, systems support, and initiatives for process improvement.

• Provide support to internal teams, external partners, and stakeholders involved in claims processing, provider data management, and claims customer services.

• Analyze, troubleshoot, and resolve issues related to claims, provider networks, and benefits.

• Act as a liaison between internal departments and external vendors or PACE program partners.

• Oversee claims quality and integrity, addressing discrepancies with IT or other teams.

• Maintain accurate documentation of workflows, business rules, and changes in processes.

• Coordinate the implementation of newly covered services and system upgrades.

• Generate and distribute reports while providing analyses for business decisions and regulatory compliance.

• Assist in testing system updates and enhancements, including user acceptance testing (UAT).

• Identify opportunities for process improvements and engage in initiatives that enhance operational efficiency and member experience.

• Stay informed about regulatory and industry changes that impact PACE operations.

⛳️ Requirements

• Bachelor’s degree in healthcare administration, business, or a related field, or equivalent professional experience.

• A minimum of 4 years of experience in a healthcare claims environment or health insurance.

• Strong analytical and problem-solving abilities.

• Proficiency in Microsoft Excel, data tools, and reporting software.

• Exceptional written and verbal communication skills.

• Capability to work both independently and collaboratively in a high-paced environment.

• Experience with payer health plan systems such as Plexis, Facets, QNXT, Epic Tapestry, or similar systems is preferred.

• Familiarity with HIPAA, Medicare, Medicaid, or ACA regulations is preferred.

• SQL or other data querying skills are a plus.

• Applicants from Florida must undergo 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 accidental death and dismemberment (AD&D) coverage.

• Supplemental life insurance.

• Flexible spending accounts.

• 401(k) savings plan with company matching.

• Paid time off.

• Company-paid holidays.

• Commitment to equal opportunity and affirmative action in the workplace.

• A diverse and inclusive working environment.

• A patient-centered care model.

• Collaborate with talented, respectful, and passionate colleagues.