Payment Integrity Analyst I

What We Are Looking For

We are always searching for unique people to add to our team. We only hire people that care deeply about others, thrive in evolving environments, gain satisfaction from being part of a team, are motivated by tackling complex challenges, are courageous enough to share ideas, action-oriented, resilient, and results-driven.

What You Can Expect

• An inclusive, flexible, and fun culture
• A comprehensive salary, pay transparency
• Benefits and time off package
• Pleasant personal development and growth opportunities

How You Will Make a Difference

The Payment Integrity Analyst ensures assigned payment integrity programs are delivered efficiently and with high quality. Using claims expertise, program knowledge, and analytics capability, this person will provide the day-to-day management of assigned programs which may include, but aren't limited to, our CMS Demand Case program and our Subrogation program. They will research case questions, resolve issues, identify process and program improvements, and ultimately contribute to the delivery of a strong portfolio of payment integrity programs.

• Provide strong analytical, problem-solving and quality assurance skills to support efficient, accurate and timely execution of assigned payment integrity programs
• Combine healthcare knowledge and technical skills using programs including QicLink and Excel and reporting from vendor systems to gather, assess, and perform detailed evaluations of data to: Identify issues, recommend solutions, and manage situations to resolution
• Identify, evaluate and deliver new program improvements that increase cost containment results for HMA and its clients
• Track, manage, and report on daily program inventory for short-term prioritization and long-term strategic planning
• Evaluate existing business processes and policies and develop sustainable, measurable improvements
• Produce clear written documentation to ensure consistent and accurate service provision, such as Procedural Work Instructions or Job Aids for core practices and business requirements for program changes
• Collaborate effectively with internal teams including Appeals, Claims, Client Success, and Stop Loss to deliver an informed, coordinated experience for clients and members
• Interact and communicate effectively with payment integrity program vendors and government agencies to meet program expectations
• Maintain current in knowledge of claims processing, job-related systems, and associated government regulations, and pursue education and training relevant to Payment Analyst role

Requirements

• A High School Diploma required
• ICD-10 & CPT experience required
• 3-5+ years of claims processing experience within the insurance industry
• 2+ years of data entry experience
• Intermediate Excel skills with the ability to build effective spreadsheets and manipulate data
• Able to manage a complex daily queue and prioritize workload effectively
• Skilled in identifying root causes of issues through detailed investigation and inquiry
• Able to analyze impacts of potential actions or decisions to determine the optimal choice

Benefits

• Compensation: The base salary range for this position in the greater Seattle area is $73,000-$81,000 and varies dependent on geography, skills, experience, education, and other job or market-related factors.
• Performance-based incentive bonus(es) is available.

Disclaimer

The salary, other compensation, and benefits information are accurate as of this posting date. HMA reserves the right to modify this information at any time, subject to applicable law. In addition, HMA provides a generous total rewards package for full-time employees that includes: Seventeen (IC) days paid time off (individual contributors), Twelve paid holidays, Two paid personal and one paid volunteer day, Company-subsidized medical, dental, vision, and prescription insurance, Company-paid disability, life, and AD&D insurances, Voluntary insurances, HSA and FSA pre-tax programs, 401(k)-retirement plan with company match, Annual $500 wellness incentive and a $600 wellness reimbursement, Remote work and continuing education reimbursements, Discount program, Parental leave, Up to $1,000 annual charitable giving match