Payment Integrity Professional

We are looking for an Analyst, QA and Operations to join the Payment Integrity team.

What You’ll Be Doing:

Perform QA of data mining, fraud, waste and error concepts identified
Review retraction files and assign them for processing by the funding and recovery team
Help develop training and build processes as needed
Acting as liaison between Plan/Vendor and Operations team as needed
Research discrepancies between identified overpayments and F&R findings
Assist across clients as needed
Develop and provide training/guidance to ops manager and QA PI team
Provide support for F&R when questions or concerns arise
Collaborate within the PI team and across other departments to identify issues and craft solutions
Identify issues or inconsistencies within data and processes and take initiative to find solutions or correct the problem
Other duties as assigned.

The Experience You’ll Need (Required):

BA degree OR equivalent combination of education and work experience
5 years of extensive healthcare knowledge including Medicare, Medicaid, and commercial plans
Understanding of claims billing and payment (ICD 9 & ICD 10)
Strong critical thinking and analytic skills
Able to collaborate with others and work independently on multiple projects at a time
Strong written and verbal communication skills

Apply Now!