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HealthEdge · 5 hours ago

Senior Payment Integrity Analyst

United States

Full-time

Remote

Mid, Senior Level

$80K/yr - $110K/yr

3+ years exp

HealthEdge is a company focused on transforming the payment integrity landscape in healthcare. They are seeking a Senior Payment Integrity Analyst to develop requirements for proprietary healthcare edits and collaborate with various stakeholders to ensure effective implementation and optimization of these edits.

Enterprise SoftwareHealth CareProduct DesignSoftware

Responsibilities

Develop requirements for proprietary healthcare edits, conducting comprehensive reviews of contracts, policies, and state/federal guidelines

Drive collaboration with subject matter experts and technical teams to translate these requirements into functional specifications for our proprietary healthcare edits

Own the communication of proposed proprietary healthcare edits to internal and external stakeholders, ensuring clarity and addressing any questions or concerns

Be responsible for creating and maintaining detailed documentation to support the building and implementation of proprietary healthcare edits, including specifications, test plans, and user guides

Provide continuous monitoring and evaluation of the performance of proprietary healthcare edits, proactively identifying opportunities for optimization and enhancement based on industry trends and regulatory changes

Qualification

Healthcare payment integrityClaims processingHealthcare contractsDocumentation management toolsAnalytical skillsCommunication skillsProblem-solving skills

Required

Bachelor's degree in Healthcare Administration, Business, Finance, Computer Science, or a related field

Minimum of 3 years of experience in healthcare payment integrity, content & policy, contracts, claims processing, or a closely related field

Strong understanding of healthcare contracts, policies, and regulatory guidelines

Proven track record of developing and implementing proprietary healthcare edits, and/or healthcare content & policy, preferably within a software development or healthcare IT environment

Excellent communication and interpersonal skills, with the ability to effectively collaborate with cross-functional teams and communicate technical concepts to non-technical stakeholders

Strong analytical and problem-solving abilities, with a detail-oriented approach to reviewing contracts, policies, and regulatory guidelines

Experience with documentation management tools and methodologies, such as Confluence or SharePoint