Sagility · 7 hours ago

Payment Accuracy Analyst

United States

Full-time

Remote

Mid Level

4+ years exp

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Responsibilities

Utilizing healthcare experience to perform audit recovery procedures

Identify overpaid claims

Identifying and defining issues, developing criteria, reviewing, and analyzing contracts and Health Plan reimbursement policies and the various state and federal regulations

Entering and documenting the incorrect payment issue into Devlin’s systems accurately and in accordance with standard procedures

Updating and developing new and current audit recovery report ideas and then working with the IT team to automate the process

Researching reimbursement regulations for claim payment compliance reviews and documentation to support current audit findings

Qualification

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Claims auditing experienceMedical claim data analysisPayment integrity conceptsMicrosoft Office proficiencyFraud detection methodologiesHealthcare experienceFinancial transactions knowledgeEnd-to-end claims processesAudit recovery reportingCollaboration with stakeholders

Required

High School Diploma or equivalent required.

4 -5+ year’s knowledge of direct claim processing/reimbursement, medical facility contracts, fee schedules, inpatient/outpatient/physician claims required.

Prior claims auditing or consulting experience desirable in either a provider or payer environment.

Excellent communication skills both oral and written.

Strong interpersonal skills that will support collaborative teamwork.

Microsoft Office Proficient: Word and Excel; Access – highly preferred.

Provide recommendations for improving payment integrity processes, fraud prevention measures, and operational efficiency based on audit findings.

Collaborate & establish strong relationships with internal and external stakeholders to define, align and delivery payment accuracy initiatives.

Work with audit teams and establish a process to ensure the concepts being deployed are working as expected with higher findings thus ensuring higher hit rates and findings rates on the concepts deployed.

Preferred

Knowledge of payment systems, financial transactions, and claims processes end to end.

Understanding of payment integrity concepts and fraud detection methodologies.

Experience in auditing, payment processing, or financial fraud prevention is a plus.

Experience working within a health plan, managed care organization, provider operated healthcare environment or third-party administrator.

Development of end-to-end payment Integrity reports like Data Intake, Audit Selections, Findings, Appeals, Medical record Management, Audit Operations, Recovery Operations, Provider Correspondence and Forecasting & Invoicing.