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Elevance Health · 19 hours ago

Payment Integrity Business Analyst III

VA-NORFOLK, 5800 NORTHAMPTON BLVD

Full-time

Hybrid

Mid, Senior Level

5+ years exp

Elevance Health is a health company dedicated to improving lives and communities. The Payment Integrity Business Analyst III is responsible for reviewing and analyzing payment integrity recovery requests, assessing their validity, and identifying new recovery opportunities while serving as a liaison between business and IT.

Health CareHealth InsurancePersonal HealthWellness

H1B Sponsor Likely

Responsibilities

Analyzes complex end user needs to determine optimal means of meeting those needs

Determines specific business application software requirements to address complex business needs

Develops project plans and identifies and coordinates resources, involving those outside the unit

Works with programming staff to ensure requirements will be incorporated into system design and testing

Acts as a resource to users of the software to address questions/issues

May provide direction and guidance to team members and serves as an expert for the team

Review and evaluate payment integrity recovery requests from external partners to determine validity and appropriateness

Analyze claim data to confirm recovery eligibility using applicable CPT, HCPCS, and ICD-10 codes

Utilize systems such as Facets and Macess to research claims, validate overpayments, and document findings

Apply claims processing knowledge to identify patterns or issues that may lead to new recovery opportunities

Leverage external and internal resources such as the CMS website, State Medicaid websites, and the Knowledge Library to validate recovery requests and ensure regulatory accuracy

Collaborate with internal teams to clarify claim details and ensure accurate communication with partners

Prepare and maintain detailed documentation supporting recovery decisions

Provide recommendations for process improvement and assist with the implementation of corrective actions

Ensure compliance with all internal policies, regulatory requirements, and partner agreements

Qualification

Claims processingPayment integrityCPT codingICD-10 codingFacetsMacessData analysisAnalytical skillsProblem-solvingCommunication skillsAttention to detail

Required

Requires a BA/BS and minimum of 5 years business analysis experience; or any combination of education and experience which would provide an equivalent background

Preferred

2–4 years of experience in healthcare claims analysis, payment integrity, claims recovery functions or related field strongly preferred

3-5 years claims adjusting experience

Proficient in Facets, Macess, and Microsoft Office Suite (Excel, Word, Outlook) preferred

Working knowledge of CPT, HCPCS, and ICD-10 coding, medical claims processing workflows and systems preferred

Experience demonstrating analytical, critical thinking, and problem-solving skills preferred

Prior experience identifying or developing new recovery lead preferred

Experience with data analysis or query tools (e.g., SQL, Tableau, or similar) preferred

Experience with strong attention to detail and ability to manage multiple tasks in a fast-paced environment preferred

Effective verbal and written communication skills preferred

Experience in daily performance metrics and turnaround expectations environment preferred

Benefits

Merit increases

Paid holidays

Paid Time Off

Incentive bonus programs

Medical

Dental

Vision

Short and long term disability benefits

401(k) +match

Stock purchase plan

Life insurance

Wellness programs

Financial education resources

Company

Elevance Health

Glassdoor3.6

Elevance Health is an integrated whole-health approach to help people in health journey and address their full range of needs.

Founded in 1944

Indianapolis, Indiana, USA

10001+ employees

https://www.elevancehealth.com

H1B Sponsorship

Elevance Health has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

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2022 (222)