Claims Payment Integrity Analyst

2 days ago

🇺🇸 United States – Remote

🏄 California – Remote

Although this job is listed in California, this company may be open to hiring remote in other states.

💵 $29 - $36 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

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The Princess Margaret Hospital

WebsiteLinkedInAll Job Openings

201 - 500 employees

⚕️ Healthcare Insurance

🧘 Wellness

Description

• We are seeking a detail-oriented and analytical Claims Analyst to join our healthcare team. • Act as the primary vendor relationship owner with external payment integrity partners to detect anomalies in claims data. • Work on preventing unnecessary payments to providers and recover overpayments. • Contribute to the investigations of fraud, waste and financial recovery. • Interact and build partnerships with Prospect Medical Systems' Operations, IT teams, and external vendors.

Requirements

• Bachelors in Health Administration or 3+ years experience in Managed Care and Claims Operations in IPA setting; or equivalent combination of education and experience required. • 3+ years of experience as a medical claims analyst, adjuster, or senior examiner • Extensive knowledge of claims processing guidelines, including, perspective payment systems, DRG payment systems, comprehensive coding edits, Medicare guidelines, and Medi-Cal guidelines • Certified Professional Coder, CPC license • Master's Degree in HealthCare Administration or equivalent. Microsoft Power Bl, SQL experience • Athena, IDX System experience • 2+ years of supervisory experience in the healthcare industry