Payment Integrity Analyst

Corewell Health • Grand Rapids, MI

1d • Onsite

About The Position

Applies analytical and technical skills to assist in the development of solutions to prevent overpayments identified by vendors and through other means. Applies root cause analysis findings to assist with developing overpayment prevention solutions and assist implementation efforts within Priority Health. Works with vendors and other key business areas to address the effectiveness of overpayment prevention solutions and identify potential solution enhancements as necessary. Also may be responsible for stop loss analysis.

Requirements

• Associate's Degree or equivalent preferably in a health or business related degree
• 2 years of relevant experience Health plan operations experience to include end to end claims operations and processes.
• Experience with root cause analysis.
• CRT-Professional Coder - AAPC American Academy of Professional Coders Upon Hire preferred Or
• CRT-Coding Specialist (CCS) - AHIMA American Health Information Management Association Upon Hire preferred Or
• CRT-Coding Specialist, Certified-Physician Based (CCS-P) - AHIMA American Health Information Management Association Upon Hire preferred Or
• CRT-Registered Health Information Administrator (RHIA) - AHIMA American Health Information Management Association Upon Hire preferred Or
• CRT-Registered Health Information Technician (RHIT) - AAPC American Academy of Professional Coders Upon Hire preferred Or

Nice To Haves

• Bachelor's Degree preferably in a health or business related degree

Responsibilities

• Coordinate with vendors to review findings and identify methods to increase claims payment accuracy and integrity.
• Ability to manage and resolve conflicting points of view from providers and internal departments (includes appeals to health plan for Payment Integrity initiatives).
• Analyze results of ongoing leakage and prevention monitoring to identify inefficiencies and improve solution effectiveness.
• Coordinate and support activities related to vendor contracts. Manage proper controls for vendor invoicing, validation, reconciliations and adjustments. Prepare check requests for vendor payments.
• Coordinate with other departments as needed to accomplish cross–departmental projects and/or goals.
• Analyze and review initial, subsequent and or final filings to ensure submissions received are covered and eligibility requirements are satisfied per the groups stop loss policy (SPD, stop loss policy, fee disclosure).
• Examine claims for stop loss eligibility including verifying stop loss coverage, eligibility (knowledge of plan eligibility requirements including FMLA, MLOA, COBRA).

Benefits

• Comprehensive benefits package to meet your financial, health, and work/life balance goals.
• On-demand pay program powered by Payactiv
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
• Optional identity theft protection, home and auto insurance
• Traditional and Roth retirement options with service contribution and match savings

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree