Payment Integrity Policy Analyst
$72,500–$90,600 year
RemoteUnited States
Job Summary
Investigate market industry trends and perform data analytics to analyze the financial performance of provider sponsors and risk panels. Research contracts to ensure compliance with recommended payment integrity policies and present those policies to the executive team and provider sponsors. Create and maintain payment integrity policies for external communication while leading cross-functional teams to implement them. Review, analyze, and respond to internal or external audits and escalated provider payment integrity policy appeals. Analyze regulatory compliance regarding federal, state, and ERIS regulations to ensure alignment with market standards.
Required Qualifications
- Bachelor's degree with 2+ years of payment integrity, coding integrity or revenue integrity experience
- OR associate degree with 5+ years of payment integrity, coding integrity, or revenue integrity experience
- OR high school equivalency with 8+ years of payment integrity, coding integrity, or revenue integrity experience
- Completion of a medical coding program, health information technology, or health information management
- Certification in CPC, COC, RHIT, RHIA, CCA, and/or CCS
- Ability to demonstrate understanding of CMS and commercial payer policy in written and verbal format
- Strong understanding of claim process, ICD-10 coding, DRG validation, etc
- Strong understanding of healthcare revenue cycle and claims reimbursement
- Proficient in data analytic tools
- Comfortable interfacing with providers at the executive level
- Demonstrate ability to manage multiple projects, set priorities, and adhere to committed schedule
- Strong interpersonal skills and adaptive communication style, complex problem solving, drive for results, innovative
- Excellent written and verbal communication skills including ability to synthesize complex information
- Proven track record of delivering concrete results in strategic projects/programs
- Strong analytical ability and distilling data into actionable results
- Access to high-speed, non-satellite Internet
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