Payment Integrity Business Analyst II

This is a fully remote position, open to applicants in Arizona, +5 more states.

📋 Description

• Conduct analysis and interpretation to connect business requirements and objectives for the designated function.

• Investigate, identify, confirm, and document overpaid claims and recovery opportunities through claims analysis, reimbursement assessments, coding validation, and adherence to regulatory and payment policy guidelines.

• Oversee and evaluate recovery concepts and claim results throughout the review process.

• Collaborate with Medical Economics, Payment Integrity Operations, Claims, and BTS to address issues, validate findings, and enhance savings performance.

• Support business initiatives by conducting data analysis, identifying implementation challenges, and performing user acceptance testing for new systems.

• Identify and evaluate user requirements, procedures, and issues to enhance existing processes.

• Conduct thorough analysis on assigned projects, provide business solution recommendations, and assist with their implementation.

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

• Develop and integrate organizational best practices into business applications.

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

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

• Perform other assigned duties as needed.

• Adhere to all policies and standards.

⛳️ Requirements

• Must have authorization to work in the U.S. without requiring employment-based visa sponsorship now or in the future.

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

• A minimum of 2 years of experience in business process analysis, preferably within healthcare (e.g., documenting business processes, gathering requirements), or claims payment/analysis experience.

• Preferred experience in Payment Integrity and healthcare claims auditing.

• Medical coding certification is preferred.

• Strong analytical skills and expertise in root cause analysis are preferred.

• Advanced 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 with structured testing is preferred.

🏝️ Benefits

• Competitive pay.

• Health insurance.

• 401K plan.

• Stock purchase plan.

• 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.