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Emergent Holdings · 1 week ago

Analyst - Senior - Payment Integrity Unit

Detroit, MI

Full-time

Onsite

Mid, Senior Level

4+ years exp

Emergent Holdings is a company focused on enhancing business decision-making capabilities. They are seeking a Senior Analyst to lead the development and implementation of programs and strategies while improving workflows and processes to enhance customer service and operational efficiency.

Health CareInformation ServicesInformation TechnologyInsuranceMedical

Comp. & Benefits

Responsibilities

Identify and analyze operational data and develop insights in support of business objectives

Develop and improve work flows and business processes within defined areas to improve customer service, decrease operational costs and improve overall quality

Identify and/or analyze business problems and develop recommendations for solutions to problems

Lead the development and implementation of projects and/or teams in order to produce desired results

Document and communicate project concepts, milestones and results

Recommend and assist with implementing standard policies and procedures

Ensure that corporate compliance is communicated, implemented and monitored on an ongoing basis

Participate in systems testing, develop procedures/controls and provide recommendations for the ongoing improvement of the updated process

Provide support to internal departments and external entities by answering questions, supplying information and training

Create and present reports and presentations to display operational data and proposed business changes

Qualification

Analytical skillsProblem-solving skillsProject managementMicrosoft Office SuiteHealth insurance knowledgeCommunication skillsOrganizational skillsInterpersonal skills

Required

Four (4) years of experience in a related field is required

Excellent analytical and problem-solving skills to identify, evaluate, recommend and implement changes to processes or procedures to address problems and improve departmental effectiveness

Organizational skills and ability to prioritize; must be able to lead multiple activities with varying timelines

Excellent verbal, written communication and interpersonal skills

Ability to lead and contribute to business unit and/or corporate projects

Proficient in Microsoft Office Suites

Ability to develop and maintain effective working relationships

Preferred

Bachelor's Degree in a related field is preferred

Possess a comprehensive understanding and knowledge of the basic tenets of health insurance, the managed care model, Commercial (Facility and Professional lines of services), Coordination of Benefits, Medicare & Medicaid rules, claim adjudication process including clinical and medical billing and coding procedures and reimbursement practices

Payment integrity systems knowledge preferred

Knowledge of BCBSM and/or Blue Cross Blue Shield Association guidelines and regulation preferred

Excellent analytical, decision making, organizational, planning, creative problem solving, and ability to work with minimal direction

Excellent verbal and written communication/presentation skills

Working knowledge of: Microsoft Office Suite

Company

Emergent Holdings

Emergent Holdings’ elite team makes lives, companies and communities better! Emergent Holdings is driven by a singular goal — improving the health and safety of our customers and our communities.

Founded in 2000

Lansing, Michigan, USA

1001-5000 employees