Payment Integrity Analytics Specialist

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

📋 Description

• Design, maintain, and distribute dashboards, reports, and performance scorecards focused on payment integrity.

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

• Conduct analyses of claims, provider data, reimbursement, and audit information to uncover payment integrity opportunities and emerging trends.

• Assist in the detection of fraud, waste, and abuse through data analysis and reporting mechanisms.

• Evaluate vendor performance and verify reported recoveries, savings, and compliance with contractual performance metrics.

• Create regular operational, financial, and executive reports.

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

• Aid in audit targeting, provider outlier analysis, and the identification of recovery opportunities.

• Generate 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.

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

• Assist with budgeting, forecasting, and performance measurement activities related to payment integrity programs.

• Support regulatory reporting, audits, and documentation requests.

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

• Carry out other responsibilities as assigned.

⛳️ 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.

• A 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 necessary.

• Proficiency in data analysis and reporting techniques is essential.

• Competence in Microsoft Excel and reporting tools is required.

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

• Experience with SQL, Power BI, Tableau, or similar reporting platforms is preferred.

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

• Capability to adhere to privacy policies and HIPAA laws and regulations regarding the confidentiality and security of protected health information.

• Proficiency in reading and understanding both written and spoken English is required.

• Ability to communicate clearly and effectively is necessary.

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

• Must meet department and company performance and attendance expectations.

🏝️ Benefits

• Equal opportunity employer.

• Work-from-home arrangement specified by location field (WFH: GA).

• Ergonomically configured equipment provided.

• Travel is required approximately 5% of the time.

• Employment remains at-will.