HealthEdge · 6 hours ago

Senior Payment Integrity Analyst

United States

Full-time

Remote

Mid, Senior Level

3+ years exp

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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

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Healthcare payment integrityClaims processingHealthcare contractsRegulatory guidelinesDocumentation management toolsConfluenceSharePointDetail-oriented approach

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.