Payment Integrity Business Analyst

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

📋 Description

• Collaborate with existing and upcoming client Payment Integrity Audit initiatives to define and document business requirements for clients.

• Oversee the audit inventory for aging, prioritization, and forecasting purposes.

• Work together with managers, reporting and support teams, and other internal stakeholders to resolve issues promptly.

• Provide reporting logic to the reporting teams to ensure precise inventory and Monthly Business Review (MBR) reporting.

• Assist in operational projects aimed at enhancing processes.

• Maintain templates for provider audit letters and manage client-requested approvals and updates.

• Address provider inquiries related to medical records and audit requests.

• Identify opportunities for process improvements and assist with their implementation.

• Access client claim systems to verify claims and reimbursement terms.

• Manage the provider manager address application.

⛳️ Requirements

• A minimum of 5 years of experience in Payment Integrity Audit & Recovery Programs.

• Strong analytical capabilities, meticulous attention to detail, and effective problem-solving skills.

• Experience in Project Management.

• Proficiency in data-driven problem solving.

• Advanced knowledge of Microsoft Excel, Word, Teams, and other standard business applications.

• Exceptional verbal and written communication skills.

• Ability to manage multiple tasks in a high-paced environment while maintaining attention to detail.

• Capacity to build and sustain strong interdepartmental relationships.

• Dependable, responsive, and accountable, demonstrating a strong sense of ownership over assigned follow-up tasks.

• Bachelor’s degree preferred or equivalent experience in payment integrity services.

🏝️ Benefits

• An exciting, fast-paced, and innovative working environment.

• Opportunity to collaborate closely with seasoned healthcare, quality, and audit professionals.

• Learning opportunities within the healthcare Payment Integrity domain.

• Development of teamwork, communication, organizational, and time-management skills.

• Exposure to healthcare audit operations, onboarding coordination, managerial support, and operational systems and processes.

• Additional growth and development opportunities.