Payment Integrity Analyst jobs in United States
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InnovAge · 16 hours ago

Payment Integrity Analyst

InnovAge is dedicated to empowering seniors to live independently, and they are seeking a Payment Integrity Analyst to provide quality and operational support for PACE program administration. This role involves analyzing claims, troubleshooting operational issues, and ensuring accurate network operations across various functions.

Health CareHome Health CarePersonal Health

Responsibilities

Analyze, troubleshoot, and resolve operational issues related to claims, provider networks, and benefits
Act as a liaison between internal departments (e.g., IT, claims, customer service) and external vendors or PACE program partners
Monitor claims quality and integrity in systems and work with IT or other teams to resolve discrepancies
Maintain documentation of workflows, business rules, and process changes
Support the implementation of newly covered services and upgrades through coordination with cross-functional teams
Create and distribute reports, provide analyses to support business decisions and ensure compliance with regulatory requirements
Assist with testing system updates and enhancements, including user acceptance testing (UAT)
Identify process improvement opportunities and participate in initiatives to enhance operational efficiency and member experience
Stay updated on regulatory and industry changes affecting PACE program operations

Qualification

Claims healthcare experienceAnalytical skillsMicrosoft Excel proficiencyPayer health plan systemsHIPAA regulationsSQL skillsProblem-solving skillsWritten communication skillsVerbal communication skillsCollaborative skillsWork independently

Required

Bachelor's degree in healthcare administration, business, or related field, or equivalent work experience
4+ years of experience in claims healthcare environment or health insurance
Strong analytical and problem-solving skills
Proficient in Microsoft Excel, with experience using data tools and reporting software
Excellent written and verbal communication skills
Ability to work independently and collaboratively in a fast-paced environment

Preferred

Experience with payer health plan systems (e.g., Plexis, Facets, QNXT, Epic Tapestry, or similar)
Knowledge of HIPAA, Medicare, Medicaid, or ACA regulations
SQL or other data query skills a plus

Benefits

Medical/dental/vision insurance
Short and long-term disability
Life insurance and AD&D
Supplemental life insurance
Flexible spending accounts
401(k) savings
Paid time off
Company-paid holidays

Company

InnovAge

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InnovAge mission is to enable seniors to age independently in their own homes for as long as possible.

Funding

Current Stage
Public Company
Total Funding
unknown
2021-03-03IPO
2016-05-16Acquired

Leadership Team

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Patrick Blair
President & CEO
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Benjamin C. Adams
Chief Financial Officer
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Company data provided by crunchbase