Payment Integrity Analyst

The Payment Integrity (PI) Analyst will assist in the development of a strategic roadmap to recover, eliminate, and prevent unnecessary medical-expense spending and support the execution for a comprehensive claim accuracy program. The incumbent will optimize pre/post claim editing, auditing, and claim recovery programs that will drive incremental value year over year. The PI Analyst will employ use of analytics, trends, competitor benchmarking, and outcomes to continually identify savings opportunities, develop mitigation strategies to avoid future overpayments/underpayments, and implement plans to achieve business goals.

Job Description

Assist in the development a stellar payment integrity unit capable of proactively identifying and investigating payment issues and working with stakeholders to develop mitigation strategies to prevent future occurrences, with the ability to review impacts holistically.

Assist in the development of a comprehensive,...