Research Analyst – Medical Management

This is a fully remote position, open to applicants in California, +2 more states.

📋 Description

• Identifying, developing, and implementing solutions to enhance the accuracy and integrity of claims payments throughout the Plan.

• Concentrating on the prevention and reduction of unnecessary expenditures by outlining PI initiatives, analyzing claims data, and formulating a comprehensive implementation assessment plan.

• Collaborating with both internal and external stakeholders to streamline payment processes.

• Utilizing an extensive understanding of Providence Health Plan's infrastructure, claims editing and processing platforms, Plan policy, regulatory/compliance matters, benefits, and contracting functions to generate meaningful and actionable recommendations for PI initiatives.

⛳️ Requirements

• Bachelor’s Degree or 3 years of equivalent experience.

• 3 years of experience utilizing performance improvement and organizational change tools.

• 3 years of experience working with large datasets and analytics teams.

• 3 years of claims processing experience in the health insurance sector.

• Familiarity with reimbursement methodologies, including those of the Centers for Medicare & Medicaid Services (CMS), provider contracts, and medical coding practices.

• Healthcare experience in project coordination covering operations analysis, outcomes measurement methodology, data management, and quality improvement process design.

🏝️ Benefits

• Health care benefits (medical, dental, vision)

• 401(k) Savings Plan with employer matching

• Life insurance

• Disability insurance

• Paid parental leave

• Vacations

• Holidays

• Health issues time off

• Voluntary benefits

• Well-being resources