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Quartz · 4 weeks ago

Payment Integrity Policy Analyst

Madison, WI

Full-time

Onsite

Entry, Mid Level

$71K/yr - $89K/yr

2+ years exp

Quartz is launching a new Payment Integrity Department and is seeking an experienced Medical Coder to shape this critical function. The role involves influencing strategy, developing policies, and collaborating with a team focused on coding accuracy and payment integrity in healthcare.

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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

Payment Integrity ExperienceMedical Coding ProgramCPC CertificationBusiness ObjectsExcelICD-10 CodingClaims ProcessingHealthcare Revenue CycleProvider Engagement

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

Intermediate to Advanced knowledge in Business Objects and Excel

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

We offer an excellent benefit and compensation package, opportunity for career advancement and a professional culture built on the foundations of Respect, Responsibility, Resourcefulness and Relationships.