Payment Integrity Analyst I
New
H
Healthcare Management AdministratorsHealthcare Administration
We hire people from across the US (excluding the state of Hawaii and the cities of Los Angeles and San Francisco.), Supports people in all time zones across the US.Full-TimeEntry
SalaryThe base salary range for this position in the greater Seattle area is $73,000-$81,000
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Job Details
- Experience
- 3-5+ year of claims processing experience; 2+ year data entry experience
- Required Skills
- Analytical SkillsMicrosoft ExcelData entryQuality Assurance
Requirements
- High School Diploma.
- ICD-10 and CPT coding knowledge.
- 3-5+ years of claims processing experience within the insurance industry.
- 2+ years of data entry experience.
- Intermediate Excel skills, including building spreadsheets and data manipulation.
- Ability to manage a complex daily queue and prioritize workload effectively.
- Skilled in identifying root causes through detailed investigation.
- Capable of analyzing impacts of decisions to determine the optimal choice.
- Must pass a background screen prior to employment.
Responsibilities
- Provide analytical, problem-solving, and quality assurance support for payment integrity programs.
- Combine healthcare knowledge and technical skills using QicLink and Excel to evaluate data.
- Identify, evaluate, and deliver program improvements to increase cost containment results.
- Track, manage, and report on daily program inventory for prioritization and planning.
- Develop sustainable, measurable improvements to existing business processes and policies.
- Produce clear written documentation, including Procedural Work Instructions and Job Aids.
- Collaborate with Appeals, Claims, Client Success, and Stop Loss teams.
- Communicate with program vendors and government agencies to meet program expectations.
- Maintain current knowledge of claims processing, systems, and government regulations.
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