Quartz Health Solutions · 3 weeks ago
Payment Integrity Policy Analyst
United States
Full-time
Remote
Entry, Mid Level
$71K/yr - $89K/yr
2+ years expQuartz Health Solutions is launching a new Payment Integrity Department and is seeking an experienced Medical Coder to help shape this critical function. The role involves influencing strategy, developing new policies, and collaborating with a team focused on coding accuracy and payment integrity excellence.
Health CareHealth InsuranceInsurance
Responsibilities
Investigate, analyze, develop and implement Payment Integrity Policies
Research National, Regional, and Local health plans Payment Integrity practices to identify industry trends
Analyze financial performance of Quartz, provider sponsors, and risk pools
Reviews, analyzes, and responds to internal or external audits related to Payment Integrity Policies
Monitor regulatory compliance related to federal, state and ERISA regulations
Develop provider appeal responses in collaboration with Provider Network Management
Create educational materials to support provider understanding of Payment Integrity Policies
Review and respond to escalated provider appeals
Drive process improvements related to provider abrasion and payment integrity workflows
Qualification
Required
Bachelor's degree with 2 years of Payment Integrity, Coding Integrity, or Revenue Integrity Experience
Or Associate's degree with 5 years of Experience
Or High School equivalency with 8 years of Experience
Completion of a Medical Coding Program
Certifications in CPC, COC, RHIT, RHIA, CCA, and/or CCS
Strong Understanding of: CMS and Commercial Payer Policies
Strong Understanding of: Claims Processing and Reimbursement
Strong Understanding of: ICD-10 Coding & DRG Validation
Strong Understanding of: Healthcare Revenue Cycle Operations
Confidence engaging with providers, including discussions at the executive level
Access to high-speed, non-satellite Internet to successfully work from home
Benefits
Be a founding member of a newly created Payment Integrity department
Play a key role in building and implementing new policies and processes
Collaborate with a team that respects and values your coding and payment integrity expertise
Access professional development opportunities to support your long-term growth
Robust benefits package
Excellent benefit and compensation package
Opportunity for career advancement
Professional culture built on the foundations of Respect, Responsibility, Resourcefulness and Relationships
Company
Quartz Health Solutions
We believe that the health insurance industry should do far more than just provide access to doctors and cover or administer claims.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
B
Brian Collien
Vice President, Sales & Product Management
Company data provided by crunchbase