Lead Analyst, Payment IntegrityVirtualVocations • Fort Worth, Texas, United States
Lead Analyst, Payment Integrity
VirtualVocations • Fort Worth, Texas, United States
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A company is looking for a Lead Analyst, Payment Integrity.
Key Responsibilities
Assist in executing tasks to meet regulatory requirements and improve operational outcomes related to Payment Integrity
Manage Scorable Action Items to ensure health plan targets are met and improve claim payment accuracy
Collaborate with various teams to identify issues and implement resolution strategies while providing recommendations to health plan leadership
Required Qualifications
At least 6 years of experience as a Business Analyst or Program Manager in a Managed Care Organization or health plan setting
Proven experience in managing operational projects related to provider reimbursement and claims payment integrity
Strong knowledge of managed care claims coding and federal / state Medicaid payment rules
Skilled in Excel and SQL for data analysis to inform business decisions
Demonstrated ability to work independently in a highly regulated environment
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