Payment Integrity Analyst II

This is a fully remote position, open to applicants in Florida, +4 more states.

📋 Description

• Conduct analysis and interpretation to align business needs and objectives for the designated function.

• Facilitate business initiatives through data analysis.

• Identify barriers to implementation and oversee user acceptance testing for new systems.

• Assess and analyze user requirements, procedures, and issues to enhance existing processes.

• Execute thorough analysis on designated projects.

• Suggest potential business solutions and support their implementation.

• Improve performance management and operational reports related to new business implementation processes.

• Develop and integrate organizational best practices into business applications.

• Spearhead problem-solving and coordination efforts among various business units.

• Aid in the formulation and updating of departmental policies and procedures.

• Undertake additional duties as assigned.

• Adhere to all policies and standards.

⛳️ Requirements

• Bachelor’s degree in a related field or equivalent experience.

• Over 2 years of experience in business process analysis, preferably in healthcare or claims payment/analysis.

• Preferred experience in Payment Integrity and healthcare claims auditing.

• Medical coding certification is preferred.

• Strong analytical and root cause analysis skills are preferred.

• Proficiency in Excel is preferred.

• Experience with ticketing systems is preferred.

• Familiarity with managed care information systems is preferred.

• Experience in benefits, pricing, contracting, or claims is preferred.

• Knowledge of provider reimbursement methodologies is preferred.

• Previous experience in structured testing is preferred.

• Ability to document business processes and gather requirements.

• Compliance with all policies and standards.

🏝️ Benefits

• Competitive pay.

• Health insurance.

• 401K plan.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

• Flexible work arrangements including remote, hybrid, field, or office schedules.

• Additional incentive options may be included in total compensation.

• Equal opportunity employer committed to diversity.