Job Description

Summary:


Under the supervision of the Configuration Manager, the Payment Integrity Analyst I will work in conjunction with Business Configuration, Claims, Network, Provider Data, Utilization Management, as well as other operational departments to ensure validation and quality assurance of benefit, contract, reimbursement, and overall financial analysis that arise during the overpayment identification and recovery process.

Responsibilities:

  • Identify, analyze, and interpret trends or patterns in complex data sets.
  • Leverages available resources and systems (both internal and external) to analyze claim information and take appropriate action for payment resolution; documents all activity in accordance with organization policies.
  • Performs review of claim projects resulting from overpayments or underpayments related to benefits, contracts, and fee schedule defects.
  • Performs root cause analysis and financial impacts of identified defective c...

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