Payment Cycle Analyst II- Hybrid

Job description

Job Summary: The Payment Cycle Analyst II is responsible for providing analytical support and leadership for key Claims-related projects and initiatives. Essential Functions: - Define clinical and payment policy requirements to support configuration of clinical editing system - Conduct and research potential new reimbursement policy claim edits, including sourcing support, data analysis, consistency with Market regulatory requirements, and network impact. - Research claim results to determine potential errors/discrepancies attributed to clinical edits, claims coding, payment policies, and application of fee schedule and rates - Conduct both systemic and targeted analysis to identify reimbursement errors and determine root cause - Ensure that all clinical and payment policy analysis and documentation is prepared, reviewed, and approved prior to implementation. - Provide input to UAT and conduct post production validation of implementation results - Create effective written and oral communication materials that summarize findings and support fact based recommendations that can be shared with providers, provider associations, and Health Partner Managers - Document the status of open i...