Claims Overpayment Analyst Lead

Elevance Health • Tampa, VA

1d • $87,560 - $119,400 • Hybrid

About The Position

Claims Overpayment Analyst Lead Location : Norfolk, VA; Tampa, FL; or Hanover, MD. This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending. The Claims Overpayment/Financial Operations Analyst Lead is responsible for leading the effort to identify, analyze, validate and avoid medical overpayments. The goal is to deliver measurable cost savings through expense recovery and cost avoidance. This will include translating basic business needs into application software requirements. How you will make an impact: Primary duties may include, but are not limited to:

Requirements

• Requires a BA/BS in accounting or finance and a minimum of 5 years experience in a finance/health insurance field capacity and experience with relational databases and mainframe and client server report writers; or any combination of education and experience, which would provide an equivalent background.
• Project management experience required.

Nice To Haves

• Healthcare business analysis experience preferred.
• Experience in using Facets, SQL and MACESS highly preferred.
• Medical billing and/or claims processing experience is preferred.
• 2+ years of experience with data analysis, claims processing, provider billing, FWA investigations, cost containment, Medicare, Medicaid, MMP and/or MedSupp plans strongly preferred.
• Medical coding experience - CPT, HCPCS, ICD-9/10 coding preferred.
• CPC or applicable professional designation preferred.
• Proficient of Microsoft Office products, most notably expertise in Excel for reporting, Word, PowerPoint, Teams, and Outlook strongly preferred.
• MBA, CPA, CMA, CFA or applicable professional designation preferred.

Responsibilities

• Develops and executes complex data analysis.
• Works with programming staff to ensure requirements will be incorporated into system design and testing.
• Perform data mining utilizing CPT, HCPCS, DRG, ICD-9, ICD-10, etc., to identify recovery opportunities.
• Provides decision support and procedural input to ensure that processing efficiency does not compromise internal control mechanisms.
• Validate overpayments, complete Approach document and forward necessary files and documents for CCU Load.
• Documents and responds to any external audit requests.
• Ensures proper conversion or shutdown of legacy systems by developing and documenting enterprise solutions for successful transition to core processing systems.
• Research all resource documents and web-sites.
• Submit enhancement request for database updates.

Benefits

• In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
• We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level