Payment Integrity Analyst - Tandym

A health services network in New York City is currently seeking a new Payment Integrity Analyst for a promising opportunity with their growing team. In this role, the Payment Integrity Analyst will be responsible for assisting in the development of a strategic roadmap to recover, eliminate, and prevent unnecessary medical-expense spending and support the execution for a comprehensive claim accuracy program.

*This is a hybrid role with 2 days in the office, 3 days remote

Responsibilities:

The Payment Integrity Analyst will:

• Assist in the development a stellar payment integrity unit capable of proactively identifying and investigating payment issues and working with stakeholders to develop mitigation strategies to prevent future occurrences, with the ability to review impacts holistically
• Assist in the development of a comprehensive, strategic roadmap to recover, eliminate, and prevent unnecessary medical-expense spending by reviewing upstream and downstream processes
• Identify overpayment/underpayment opportunities by data mining, investigation, and quality review on benefit and/or provider configuration, rate loads, rate assignments, COB, claims payment logic, etc.
• Support the execution and maintenance of a corporate claim accuracy program by optimizing pre/post claim editing, auditing, and claim recovery programs
• Assist in the development and deployment of mitigation strategies to avoid future overpayments, driving incremental value year over year in both medical and administrative cost savings
• Manage the day-to-day financial recovery vendor relationships, validating that identified overpayments are valid and recouped
• Assist in the development and implementation of dashboards to monitor performance
• Complete and analyze trending reports to identify favorable/unfavorable trends
• Analyze departmental performance trends and assist with identifying new opportunities to streamline processes and improve performance of key metrics
• Assist in developing and maintaining payment integrity policies and procedures
• Perform other duties, as needed

Qualifications:

• 5+ years of Claims experience in the Healthcare and/or Insurance industry
• Bachelor's Degree
• Extensive knowledge of healthcare provider audit methods and provider payment methods, clinical aspects of patient care, medical terminology, and medical record/billing documentation
• Proven ability to apply Quantitative and/or Qualitative Research and Data Analysis techniques to improve operational processes.
• Familiar with Claim Coding practices and industry issues in Medicare Payment methodologies.
• Microsoft Excel proficient