53 applicants

Company

Original Job Post

Gainwell Technologies · 2 days ago

Senior Healthcare Analytics Research Analyst

Texas, United States

Full-time

Onsite

Senior Level

$56K/yr - $79K/yr

5+ years exp

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Responsibilities

Research client, State and Federal billing and reimbursement policies, client reimbursement practices (through review of manuals/regulations and meetings with stakeholders) to develop and configure improper payment algorithms. Results will need to be organized, documented, and trained to other team members.

Reviews provider contracts to identify algorithms for the identification of contractual based overpayments.

Performs scoping analysis and development of new overpayment algorithms.

Applies knowledge of provider billing and patient accounting practices to research client policy and data to reveal new overpayment recovery opportunities. Works with other team members, clinical staff, and key stakeholders to identify new overpayment issues for each client.

Participates in the review of health insurance claims and member eligibility information to uncover claims overpayment trends associated with non-compliance or misapplication of contract terms and rates, payment policies, medical policies, billing guidelines, and applicable regulatory requirements.

Develops data extract specifications to select claims not paid in accordance with regulations for programming with trained engineers.

Monitors internal systems used for tracking audits and findings to ensure a high degree of accuracy and maximum productivity.

Participate in the query development process and report query development progress and outcomes to leadership, internal and external clients, where necessary.

Ensures individual and departmental goals are consistently met or exceeded, in collaboration with other team members and management.

Reviews IT programming results for quality assurance and proof of concept validation.

Documents results and supports the preparation of internal and external documentation and presentations related to research and new overpayment issues.

Works with internal operations and clinical teams to develop, implement, review and audit protocols and internal review guidelines.

Uses advanced analytics to identify overpayment opportunities.

Develops and validates workflows and communication tools to best enhance audit production, client satisfaction, and quality assurance.

Works with data scientists and engineers to develop and implement technological improvements that will support the audit process.

Contributes new ideas for improving existing audit processes and audit queries.

Works cohesively with the entire audit team and internal clients.

Acts as a team lead in assisting and guiding lower-level analysts.

Develops, maintains, and ensures adherence to multiple project schedules.

Qualification

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Healthcare ReimbursementProvider Contract DevelopmentHealthcare Claims AnalysisMedical Billing/CodingPatient AccountingClaims AuditingRevenue Cycle ImprovementProblem-SolvingAnalytical ThinkingHealthcare AuditingClaims Data ValidationClaims Payment AccuracyRecovery Audit

Required

5-7 years healthcare reimbursement experience such as provider contract development, healthcare claims analysis, medical billing/coding, patient accounting, claims auditing, and/or revenue cycle improvement required.