Program Management Lead Analyst

📋 Description

• Works in collaboration with field personnel and business partners to strategize, coordinate, and implement ongoing enhancement initiatives while managing financial risks.

• Utilizes subject matter expertise and analytical abilities to collaborate with internal teams and vendors, identifying overpayment scenarios and formulating edit regulations.

• Manages designated edits throughout their entire lifecycle, executing corrective measures as necessary.

• Analyzes weekly and monthly reports to evaluate the effectiveness of aligned edits and reporting processes.

• Develops comprehensive business cases for assigned edits and reports, including root cause analysis and evaluation of financial and operational impacts.

• Investigates discrepancies and addresses foundational issues, including those related to data.

• Tracks edit performance trends to uncover opportunities for enhancement.

⛳️ Requirements

• Bachelor’s degree or higher is strongly preferred, or equivalent work experience is required.

• A minimum of 3 years of experience in medical claim processing is required.

• At least 2 years of robust knowledge in claim systems and processing, particularly with one or more of the following platforms: Proclaim, Facets, or PMHS, is required.

• Ability to effectively collaborate within a motivated team environment.

• Proven ability to work independently with minimal oversight.

• Demonstrated experience in analytical thinking and problem-solving.

• Proficiency in Microsoft Office applications, with knowledge of pivot tables and VLOOKUP being preferred.

• Capability to quickly identify issues, respond appropriately, and escalate when necessary.

• Strong interpersonal skills for engaging with vendors and internal teams.

• Excellent written, verbal, and presentation communication skills.

• Effective time management abilities.

• Understanding of audit errors and claims quality issues.

🏝️ Benefits

• Health insurance

• Vision insurance

• Dental insurance

• Well-being and behavioral health programs

• 401(k)

• Company-paid life insurance

• Tuition reimbursement

• Paid time off

• Paid holidays