Payment Integrity Analyst Senior-HP Benefit Configuration

Summary:

Under the supervision of the Configuration Manager, the Payment Integrity Analyst Senior is responsible for interpreting results using a variety of techniques; ranging from simple data aggregation via statistical analysis to complex data mining independently. Maintenance and building of fee schedules for provider contracts.

Responsibilities:

* Lead and perform complex analysis in an evolving data environment
* Lead projects that require data mining, analysis, and presentation
* Identify relevant trends, do follow up analysis and prepare visualizations
* Extract and analyze data, patterns, and related trends, with the subsequent ability to synthesize the data into information consumable by business
decision-makers
* Uses advanced research and statistical methods to conduct comprehensive analyses on the data collected from various operational processes
* Consults with requestors of informational topics related to research and decision-making analyses
* Performs other duties as assigned
* Uploading and exporting new fee schedules from CMS, Tricare (CHAMPUS), or custom into claims system.
* Research and maintaining updates of current fee schedule that are made in CMS and Tricare (CHAMPUS).
* Ability to gather and analyze data, reason logically, draw valid conclusions and make appropriate concise information and recommendation
available in both oral, written and visual formats
* Knowledge of data relationships, how data is input (manually and electronically) into the system, and how the data is reported
* Possess analytical skills related to the development of report specifications, data reporting and data modeling

Requirements:

• Bachelors Degree Preferred
• Strong background in analysis, design, development, testing and support of complex information systems with an emphasis on data integrity and quality control
• Strong Microsoft Office application skills including Microsoft Word and Excel (VLOOKUP, Pivot Tables, Index/Match, Formulas, and creating spreadsheets)
• Strong understanding of healthcare claims data, pricing, and claims editing concepts, including UB04 and HCFA 1500 claim content
• Experience with interpreting complex provider agreements
• Experience in healthcare claims adjudication, system configuration, and auditing Minimum of 6 years of

Work Type:

Full Time