Payment Integrity Analyst I

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

📋 Description

• Utilize strong analytical, problem-solving, and quality assurance skills to facilitate the efficient, accurate, and timely execution of assigned payment integrity programs.

• Integrate healthcare expertise with technical skills using applications such as QicLink and Excel, along with vendor system reports, to collect, assess, and conduct in-depth evaluations of data to:

• Identify issues, propose solutions, and effectively manage situations to resolution.

• Identify, assess, and implement new program advancements that enhance cost containment outcomes for HMA and its clients.

• Monitor, manage, and report on daily program inventory for both short-term prioritization and long-term strategic planning.

• Review current business processes and policies to create sustainable, measurable enhancements.

• Generate clear written documentation to guarantee consistent and accurate service delivery, including Procedural Work Instructions or Job Aids for essential practices and business requirements related to program modifications.

• Collaborate effectively with internal teams such as Appeals, Claims, Client Success, and Stop Loss to provide an informed and coordinated experience for clients and members.

• Engage and communicate proficiently with payment integrity program vendors and government agencies to fulfill program expectations.

• Stay updated on claims processing, job-related systems, and relevant government regulations, while pursuing ongoing education and training pertinent to the Payment Analyst role.

⛳️ Requirements

• High School Diploma is required.

• Experience with ICD-10 & CPT is required.

• A minimum of 3-5 years of claims processing experience within the insurance industry.

• At least 2 years of data entry experience.

• Intermediate Excel proficiency with the capability to create effective spreadsheets and manipulate data.

• Ability to manage a complex daily queue and prioritize workload efficiently.

• Proficient in identifying root causes of issues through careful investigation and inquiry.

• Competent in analyzing the impacts of potential actions or decisions to determine the best course of action.

🏝️ Benefits

• Seventeen (IC) days of paid time off for individual contributors.

• Twelve paid holidays.

• Two paid personal days and one paid volunteer day.

• Company-subsidized medical, dental, vision, and prescription insurance.

• Company-paid disability, life, and AD&D insurance.

• Voluntary insurance options.

• HSA and FSA pre-tax programs.

• 401(k) retirement plan with company matching.

• Annual $500 wellness incentive and a $600 wellness reimbursement.

• Options for remote work and reimbursement for continuing education.

• Employee discount program.

• Parental leave.

• Up to $1,000 annual charitable giving match.