Senior Analyst, Vendor Payment Integrity - Remote
EmblemHealth
Summary of Job Review vendor trends and impact on care cost, member and provider experience. Perform Root Cause Analysis (RCA) to resolve payment integrity issues to resolution. Initiate project requests, develop or support the development of care cost impacts, partnering with external vendors, and/or Healthcare Economics. Support vendor relationship to ensure external and internal expectations are met. Responsbilities
- Responsible for analyzing specific contracts in Enterprise Payment Integrity.
- Serve as a primary subject matter expert for each contract to ensure optimal contract management and outcomes.
- Evaluate feasibility of implementing interim workflow processes as a stop gap to provider abrasion and interest payments.
- Act as a point of communication and coordination with all internal business units for all issues related to vendor contracts.
- Ensure current and future state analysis is performed, business requirements and change requests are analyzed and accurately documented and aligned with business needs.
- Responsible for "end to end" contract management which includes performing all pre-contractual and implementation activities, business ownership of EPMO and IT projects, development of contract performance standards and associated penalties, root cause analysis and ongoing monitoring and oversight.
- Review content of new Payment Integrity contracts and provide input as appropriate
- Partner with business and IT to develop testing strategy, test plans and functional test cases. Participate in the development and execution of user test plans to ensure that the system design meets business needs.
- Actively participate in all related Policy Meetings, Quarterly Business Reviews, Reimbursement Policy Committees, Steering Committees.
- Create monthly savings reports and identify and address trends in comparison to established goals.
- Support budget process by creating requisitions, purchase orders, and accruals for each Payment Integrity program, to ensure program alignment with budget.
- Complete monthly invoices and reconcile against Oracle system reporting.
- Identify system enhancements and process improvements which will result in enhanced reporting and savings.
- Apply project management skills to complete related projects and assignments.
- Initiate claims to determine under and overpayments, presents outcomes and seeks appropriate business approvals.
- Identify and recommend new programs, savings opportunities, and ways to optimize current contracts.
- Evaluate feasibility of implementing interim workflow processes as a stop gap to provider abrasion and interest payments.
- Complete assigned Maestro cases in the appropriate Payment Integrity queues to ensure case closure within SLAs.
- Engage vendors and internal business units to review opportunities and lead business case development, savings opportunity analysis, and creation of EPMO or IT related projects.
- Bachelor's degree
- AAPC CPC - AAPC Certified Professional Coder &/or CCS - AHIMA Certified Coding Specialist (Preferred)
- Master's Degree (Preferred)
- 4 - 6 years or relevant, professional experience in health care contracting and management (Required)
- Strong understanding of the healthcare industry, managed care and health plan operations (Required)
- Experience in managing large, complex contracts (Required)
- Additional experience/specialized training/certifications may be considered in lieu of educational requirements (Required)
- Knowledge of accruals, invoicing and financial reporting (Required)
- Experience with performance improvement (Required)
- Ability to prioritize complex projects (Required)
- Excellent organizational and project management skills (Required)
- Proficiency in Microsoft product suite (Required)
- Knowledge of claims operating platforms (Preferred)
- Excellent communication skills; ability to interact appropriately/effectively across all departments and management levels (Required)
Vacancy posted 4 days ago
Similar jobs that could be interesting for youBased on the Senior Analyst, Vendor Payment Integrity - Remote in United States vacancy
- EmblemHealth is seeking a candidate for a position that involves analyzing contracts in Enterprise Payment Integrity. This role requires managing vendor relationships and ensuring effective contract management across the organization. The ideal applicant will have a Bachelor...SeniorContract work
- ...technology consulting firm is seeking a Senior Analyst to join the Edits team. This remote role involves managing the edit development lifecycle, ensuring payment accuracy, and driving process... ...5 years of experience in payment integrity or claims analytics, and hold an active...Remote jobSenior
$75k - $100k
...Senior Analyst, Edits | Payment Integrity (Remote) CGI is seeking a results-oriented Senior Analyst to join our growing Edits team. In this pivotal role, you will be responsible for expansively growing CGI's edits library and driving measurable value by identifying...Remote workSeniorCGI
Fairfax, VA23 hours ago$69.4k - $99.2k
...Senior Analyst - Payment Integrity Analytics Be part of a team that unleashes the power of leading-edge technologies to help improve the health and... ...with state Medicaid and OIG stakeholders Fully remote opportunity with the option to work anywhere within the United...Remote workSeniorFull timeWork at officeFlexible hoursGainwell Technologies
United States4 days ago$66.94k - $101.26k
...Payment Integrity Analyst II The Payment Integrity Analyst is responsible for accurately reviewing... ...denials and/or appeals, payer audits, or vendor audits Pay Range: CorVel... ...time. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted...Remote workMinimum wageFull timeWork experience placementWork at officeLocal areaFlexible hoursCERIS Health
United States3 days ago- ...Company EmblemHealth Location REMOTE Summary of Position Develop/gather... ...for queries needed to analyze vendor payment data. Utilize pre/post claim editing, auditing... ...Network Management, Finance, etc.) to integrate overpayment prevention strategies. Maintain...Remote workSenior
EmblemHealth
United States1 day ago - ...SHPCA SCAN Health Plan is seeking a Senior Manager Payment Integrity to lead a cross-functional team focused... ...care. This role involves managing vendor implementation, analyzing data trends... ...medical benefits and a 401(k) plan, mostly remote work, and opportunities for...Remote workSeniorHourly pay
SHPCA SCAN Health Plan
Long Beach, NY4 days ago $24.2 - $36.3 per hour
...care by preventing inaccurate payments and reducing overall waste in... ...for Pre-Payment Accuracy and Integrity and is HI-TRUST and SOC2... ...SUMMARY The Payment Integrity Analyst (Data Mining) supports the Data... ...as a Payment Integrity Vendor or within a Health Plan's Payment...Remote workFull timeContract workVisa sponsorshipLyric
Newtown Square, PA3 days ago$92.7k - $139.1k
...work arrangements that include remote and hybrid opportunities and... ...the organization, you’re an integral part of our team and your input... ..., in‑depth analysis of claim payments and its methodology,... ...internal stakeholders as well as vendor(s) and providers as applicable...Remote workContract workWork at officeWork from homeFlexible hoursShift work2 days per week1 day per week$83.25k - $155.51k
Job Summary Provides lead level analyst support for health plan payment integrity activities. Partners with leaders and functional representatives to drive... ...opportunities Analyze data from Payment Integrity and Vendors against contracts, billing, and processing guidelines...Remote jobTemporary workWork experience placementWork at office- ...Responsibilities The Senior Integration Analyst works under general direction to define high and low-level... ...integration details simultaneously on vendors and interface customers’ needs.... ...analysts. THIS POSITION OFFERS A FULLY REMOTE WORK OPPORTUNITY. EMPLOYEES IN THIS ROLE...Remote workSenior
Norton Healthcare
United States4 days ago - ...Senior Business Analyst - EPIC Integration We are seeking an experienced Sr. Epic Business Systems Analyst in... ...the integration platform using FHIR, Vendor Services APIs, and HL7 messages.... ...evening interactions with partners and remote teams. ~ Bachelor's degree in IT,...Remote workSeniorAfternoon shift
Saviance
United States1 day ago $112.8k - $188k
...Senior Advisor As a Senior Advisor, you'll provide strategy and analytical support for the Payment Integrity team inclusive of evaluating the current payment integrity programs, from... ...clinical, network, claims, product and vendor teams to drive measurable progress...Remote workSeniorWork from homeCarepathRx
United States4 days ago- ...Job Title Revenue Cycle Analyst Job Description Responsible for maintaining, analyzing... ...planning and analysis; clearing revenue integrity related work queues in EPIC and... ...financial systems with CDM maintenance vendor tool monthly, scripts work smoothly, new...Remote workSeniorWork experience placementInterim roleShift work
Cottage Health
United States4 days ago - ...Senior Director, Claims & Payment Integrity Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and... ...and enhance auto adjudication Delivers strong vendor oversight to optimize system processing to improve efficiency...Remote workSeniorTemporary work
Martins Point Health Care
United States3 days ago $100k - $130k
...reviewing your submission! Position: Senior Vendor Risk Analyst Location: Atlanta, GA (Hybrid – Candidates... ...energy sector client in a highly integrated capacity. Based on performance,... ...and Governance). Employee Benefits: Remote and Hybrid working environment. Competitive...Remote workSeniorFull timeTemporary workWork at officeLocal areaFlexible hours3 days per weekFortress LLC
Atlanta, GA3 days ago- ...Chain), the Tech Data team, and our System Integrator. This lead role will have ownership... ...and will partner with third party vendors to make sure Data timelines are met and... ...days at one of our core locations and 2 remote days. Our core office locations include...Remote workSeniorFull timeWork at officeLocal areaFlexible hours
Peapod Digital Labs
Hyattsville, MD1 day ago - ...Senior Payments Data Optimization Analyst Atlanta, Georgia, United States Optimized Payments is the only... ...will have the opportunity to work remote primarily. Responsibilities:... ...and escalate data discrepancies or integrity issues impacting analytics, KPIs, client...Remote workSeniorFull timeLocal areaWork from home3 days per week
Optimized Payments
Atlanta, GA3 days ago - ...Health Care Service Corporation is seeking a Sr. Manager of Payment Integrity Operations based in Chicago, IL. This role is vital in managing daily operations, ensuring effective use of enterprise information to deliver business value. The ideal candidate will have a Bachelor...Remote workSenior
Health Care Service Corporation
Chicago, IL3 days ago $51.06 - $73.9 per hour
...Senior Manager Payment Integrity SCAN began with a simple but radical idea: that older adults deserve to... ...works closely with Business, IT and vendors to ensure desired outcomes are achieved... ...73.90 per hour. Work Mode: Mostly Remote. Medical Benefits. Paid Sick...Remote workSeniorHourly payTemporary workWork at officeSCAN
United States23 hours ago- A financial services company in Houston, TX is seeking a Financial Payment Accuracy and Recovery Analyst III. This role involves ensuring accurate vendor payments according to contracts, conducting invoice audits, and providing financial analyses to recover improper payments...SeniorContract work
$68.9k - $131.1k
...Commodity Integration Senior Analyst The Global Supply Chain New Product Introduction (NPI) team... ...is designated as on-site, hybrid or remote. The salary range for this role is... ...by a collective-bargaining agreement. Payments under these annual programs are not guaranteed...Remote workSeniorTemporary workWork experience placementWork at officeFlexible hours3 days per week- ...managing outsourced facilities management vendors. Additional Information WD is... ...performed in California, Colorado, New York or remote jobs that can be performed in California,... ...and its subsidiaries will never request payment as a condition for applying for a...Remote workSeniorTemporary workImmediate startFlexible hoursShift work
Western Digital
San Jose, CA4 days ago $70k - $80k
...businesses to create amazing, integrated experiences that keep players in the game. The Senior Game Integrity Analyst plays a critical role in... ...with Customer Support, Risk, Payments, and Marketing teams to... ...domestically and internationally. #LI-REMOTE #LI-DNP This role...Remote workSeniorRush Street Interactive
Chicago, IL1 day ago$211.55k - $317.33k
...leading healthcare technology firm seeks a Senior Medical Director to provide strategic oversight for pre-payment edits and improve payment integrity. The role involves collaboration with... ...skills, and proven leadership. This remote position offers a competitive salary range...Remote workSeniorLyric
New York, NY2 days ago- Commence seeks a Healthcare Program Integrity Solutions Consultant to enhance commercial payer... ...demands expertise in healthcare fraud, payment integrity operations, and the ability to... ...offers a competitive salary, and remote opportunities are available in many states...Remote workSenior
Commence Corporation
Virginia Beach, VA4 days ago - Signature Performance is seeking a Payment Integrity Analyst to work remotely in the United States. This role focuses on preventing overpayments and ensuring compliance within healthcare claims, involving responsibilities such as leading audits, developing claims editing...Remote job
$69.38k - $92.28k
...MVP Health Care is seeking a skilled data analyst to support payment integrity and analyze healthcare claims data. This position is crucial for uncovering... ...in SQL and modern data tools. The role allows for remote work, but applicants must reside in New York or Vermont....Remote workMVP Health Care
New York, NY1 day ago- ...responsible for driving enterprise growth of Payment Integrity solutions among large national and... ..., value-driven discussions with senior payer executives. The ideal candidate will... ...executive relationships. This position is remote within the US, emphasizing collaboration...Remote workSenior
$112.7k - $193.2k
...Senior Consultant will provide support on a number of payment model implementation contracts, including operations support,... ...enjoy the flexibility to work remotely from anywhere within the U.S. For... ...and relationships, such as the Integrated Data Repository, Chronic Conditions...Remote workSeniorFull timeWork at officeLocal areaMonday to FridayShift workStryker
Washington DC13 hours ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Senior Analyst, Vendor Payment Integrity - Remote. Be the first to apply!
Related searches
- entry level analyst United States
- junior incident response analyst United States
- cash analyst United States
- workforce analyst United States
- sales and trading analyst United States
- dna analyst United States
- kyc analyst United States
- remote epic analyst United States
- packaging analyst United States
- back office analyst United States