Payment Accuracy Analyst

Role Description

The Payment Integrity Analyst is responsible for conducting research and analysis and reviewing regulatory edits for federal and state statutes, regulations, provider manuals, bulletins, and other sources as needed to identify new overpayment edit concepts, as well as, validate all prospective and retrospective overpayment results.

Essential Functions:

• Identifies, develops, and implements new concepts that will target claim overpayment scenarios for each of ACFC’s Medicaid and Medicare lines of business.
• Assists with ensuring that the current prospective and retrospective cost avoidance/overpayment recovery processes are carried out within the established deadlines with a high level of accuracy.
• Performs analysis on claims data, comparison reports, and State regulations for each state-specific edit on payer or state specific requirements.
• Communicates effectively with each of our customers throughout the organization.
• Reviews edit concept results for quality assurance and proof of concept validation.
• Reviews all available sources including federal and state statutes, regulations, provider manuals, Provider contracts, and bulletins for changes to and/or new payment rules.
• Identifies and documents changes to and/or new payment rules or language in the source document which may be utilized to update existing system edits or new system edits.
• Contributes new ideas for improving existing processes.
• Understands and applies all established SOPs for each of the teams processes.
• Adheres to line of business specific procedures to perform routine functions based on department guidelines.

Qualifications

• 3 to 5 years relevant experience (healthcare claim reimbursement methodologies, state and federal payment policies, claims, data analysis).
• Bachelor's Degree or equivalent work experience.
• Active CPC.

Requirements

• Access to a reliable high-speed internet connection for remote or hybrid roles (minimum bandwidth of 50 Mbps download and 5 Mbps upload).
• Ability to submit for reimbursement if residing in states where service is required by contract, law, or regulation.

Benefits

• Flexible work solutions including remote options and hybrid work schedules.
• Competitive pay.
• Paid time off including holidays and volunteer events.
• Health insurance coverage for you and your dependents on Day 1.
• 401(k).
• Tuition reimbursement and more.