Payment Integrity Analytics Specialist

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

📋 Description

• Design, sustain, and disseminate payment integrity dashboards, reports, and performance scorecards.

• Monitor and track recoveries, cost avoidance, savings, inventory, and operational performance metrics.

• Evaluate claims, provider, reimbursement, and audit data to uncover payment integrity opportunities and emerging trends.

• Aid in fraud, waste, and abuse detection efforts through comprehensive data analysis and reporting.

• Assess vendor performance and authenticate reported recoveries, savings, and contractual performance measures.

• Generate regular operational, financial, and executive reporting.

• Execute data validation, reconciliation, and quality assurance tasks.

• Assist with audit targeting, provider outlier analysis, and identification of recovery opportunities.

• Develop ad hoc analyses and presentations to facilitate leadership decision-making.

• Collaborate with Information Technology and enterprise data teams to enhance reporting capabilities and data accessibility.

• Detect trends, risks, and opportunities while providing data-driven recommendations to leadership.

• Support budgeting, forecasting, and performance measurement activities associated with payment integrity programs.

• Facilitate regulatory reporting, audits, and documentation requests.

• Engage in departmental meetings, assigned projects, compliance initiatives, and operational efforts.

• Fulfill department and company performance and attendance expectations.

• Adhere to PacificSource privacy policies and HIPAA regulations concerning the confidentiality and security of protected health information.

• Execute additional duties as assigned.

• Operate within a general office environment with approximately 5% travel required.

⛳️ Requirements

• A minimum of 3 years of experience in healthcare analytics, claims analytics, payment integrity, finance analytics, reimbursement analysis, or a closely related field is required.

• High school diploma or equivalent is mandatory.

• A Bachelor's degree in business, finance, statistics, data analytics, healthcare administration, information systems, or a related area is preferred.

• Familiarity with healthcare claims processing and reimbursement methodologies is essential.

• Proficiency in data analysis and reporting techniques is necessary.

• Experience with Microsoft Excel and reporting tools is required.

• Familiarity with SQL, Power BI, Tableau, or comparable reporting platforms is preferred.

• Knowledge of Medicare, Medicaid, Commercial, and Marketplace health plan operations is advantageous.

• Understanding of statistical analysis and performance measurement concepts is crucial.

• Capacity to read and comprehend both written and spoken English is mandatory.

• Strong communication skills are essential for effective interaction.

• Ability to meet department and company performance and attendance expectations is required.

• Commitment to adhering to PacificSource privacy policies and HIPAA regulations regarding confidentiality and security of protected health information is necessary.

• Capability to stoop and bend, sit and/or stand for extended durations, perform repetitive motions, and lift and carry files and business materials is required.

🏝️ Benefits

• Equal opportunity employment.

• Ergonomically configured equipment.

• Designated work-from-home location.

• At-will employment.