Payment Accuracy Analyst

Responsibilities

• Conducts research and analysis to identify new overpayment edit concepts and validate overpayment results.
• Aids in ensuring compliance with established deadlines for prospective and retrospective overpayment recovery processes.
• Analyzes claims data, comparison reports, and state regulations to ensure accuracy and adherence to payer and state-specific requirements.
• Communicates with customers across the organization to review and validate edit concept results and proof of concept validations.
• Identifies and documents changes to payment rules and updates system edits accordingly.
• Implements new ideas to improve existing processes and adheres to line of business specific procedures.

Requirements

• 3 to 5 years of relevant experience in healthcare claim reimbursement methodologies, state and federal payment policies, claims, and data analysis.
• Bachelor's degree or equivalent work experience.
• Active CPC certification.

Qualifications

• Strong analytical skills and attention to detail.
• Ability to work independently and manage multiple tasks simultaneously.
• Excellent communication and interpersonal skills.
• Proficiency in Microsoft Office Suite.

Skills

• Knowledge of healthcare reimbursement systems and processes.
• Understanding of federal and state payment policies and regulations.
• Experience with data analysis and report writing.
• Strong problem-solving and critical thinking skills.

Benefits

• Flexible work solutions including remote options and hybrid work schedules.
• Competitive pay and a robust benefits package.
• Paid time off including holidays and volunteer events.
• Health insurance coverage for you and your dependents on Day 1.
• 401(k) retirement plan with company match.
• Tuition reimbursement program.