Payment Integrity Business Analyst
About The Position
The Payment Integrity Business Analyst collaborates with Payment Integrity Audit program leaders, key client stakeholders, and cross-functional teams to define business requirements, manage audit inventory, and prioritize claims. The role works closely with reporting and support teams to develop internal reporting and audit workflows, resolve issues, and support operational process improvements. It requires a proactive, quality-focused professional experienced in payment integrity audits, project management, and inventory management who can manage multiple follow-up items, communicate clearly, and escalate issues when additional support is needed.
Requirements
- Five years of experience in Payment Integrity Audit and Recovery Programs.
- Strong analytical skills, attention to detail, and problem-solving ability.
- Project management experience.
- Data-driven problem-solving skills.
- Advanced skills in Microsoft Excel, Word, Teams, and other standard business tools.
- Excellent oral and written communication skills.
- Ability to manage multiple tasks in a fast-paced environment while maintaining attention to detail.
- Ability to build and maintain strong interdepartmental working relationships.
- Reliable, responsive, and accountable, with ownership of assigned follow-up tasks.
Nice To Haves
- Bachelor’s degree, or equivalent work experience in payment integrity services.
Responsibilities
- Collaborate across current and future client Payment Integrity Audit programs to define and document client business requirements.
- Monitor audit inventory for aging, prioritization, and forecasting.
- Partner with managers, reporting and support teams, and other internal partners to resolve issues in a timely manner.
- Provide report logic to reporting teams to support accurate inventory and MBR reporting.
- Support operational projects that drive process improvement.
- Maintain provider audit letter templates and client-requested approvals and updates.
- Address provider issues regarding medical records and audit requests.
- Identify and assist with implementing process enhancements.
- Access client claim systems to validate claims and claim reimbursement terms.
- Maintain the provider manager address application.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
