Analyst, Payment Integrity

Job description

#LI-Hybrid - Research and Analysis - Serve as contact for external vendors and internal departments to support operations and payment integrity activities. - Research and respond to low to high priority complex internal and external inquiries. - Analyze and coordinate vendor performance reviews using KPIs (e.g., recovery yield, turnaround time, false positive rates, provider abrasion). - Coordinate reconciliation of vendor invoices, validating against contractual terms, recoveries, and performance metrics. - Is proficient at utilizing a variety of resources including but not limited to on-line information files and databases, Medicare/other plan guidelines, plan certificates, provider contracts. - Update and create CES and Cotiviti pend resolutions. - Business Analysis & Reporting - Analyze operational and financial data to identify trends, savings opportunities, and anomalies. - Assess business impact of new edits and changes in medical reimbursement policies/guidelines. - Initiate, develop, coordinate and implement cost/benefit analysis of claims processing. - Develop documentation, including cost/benefit and business impact analysis and recommendations to implement and/or improv...