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MVP Health Care · 6 days ago

Professional, Overpayment Recovery and Monitoring Analyst

United States

Full-time

Remote

Mid Level

$69K/yr - $92K/yr

3+ years exp

MVP Health Care is on a mission to create a healthier future for everyone. The Professional, Overpayment Recovery and Monitoring Analyst will manage audits, identify new audit opportunities, and contribute to enhancing healthcare delivery by ensuring payment accuracy and supporting process improvements.

Health CareHealth InsuranceInsuranceMedicalNon Profit

Responsibilities

Manage recurring audit inventories, ensuring timely progression and completion of existing audits

Identify and initiate new audits as patterns emerge through risk-based monitoring efforts, datamining, and other routine payment policy reviews

Analyze new opportunities to substantiate, size, and prioritize audit needs, and develop audit protocols for new audit types

Report suspected fraud and abuse to the SIU for further investigation and identify providers in need of education

Collect and validate Key Performance Indicators (KPI's) from payment integrity functions across the organization

Assist in the reporting of monthly metrics and participate in cross-functional audit operations

Handle department projects, participate in committees relevant to payment integrity, and support process improvement efforts

Participate in training and development activities within the department and corporation

Perform other audit activities and manual reviews as requested, ensuring accuracy of claims and supporting overall payment accuracy

Perform research using "best practices" in auditing methodologies, remaining current in CPC coding, reimbursement methodologies, MVP Policies and Procedures, and updates in professional literature

Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer

Qualification

Coding certificationProfessional coding experienceBachelor's degreeProvider reimbursement knowledgeHealth Insurance knowledgeAnalytical skillsEducation initiationCuriosityHumilityCommitment to customersProblem-solving skillsAttention to detail

Required

Bachelor's degree in Health Administration, Business, Economics, Health Informatics, or related field. Associate's degree with the equivalent combination of related experience may also be considered

Coding certification, such as AAPC CPC, CIC, COC, CCS is required

The availability to work full-time, virtual in New York State

A minimum of three (3) years' experience in a professional coding environment and three (3) years' experience in auditing and/or reviewing in relevant healthcare industry experience

Intermediate knowledge of provider reimbursement methodologies and all current coding methodologies

Intermediate knowledge of Health Insurance and various plan types

Intermediate analytical, problem-solving skills and attention to details

Ability to initiate education with providers and make internal recommendations for process improvements. Goals and outcomes of the recommendations and education must be measurable

Curiosity to foster innovation and pave the way for growth

Humility to play as a team

Commitment to being the difference for our customers in every interaction

Benefits

Growth opportunities to uplevel your career

A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team

Competitive compensation and comprehensive benefits focused on well-being

An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work For in the NY Capital District, one of the Best Companies to Work For in New York, and an Inclusive Workplace.