Payment Integrity Policy Analyst

Quartz • Madison, WI

3d • $71,000 - $88,800 • Remote

About The Position

Overview Quartz is excited to launch a brand-new Payment Integrity Department , and we’re looking for an experienced Medical Coder to help shape this critical function from the ground up. If you’re passionate about coding accuracy, payment integrity, and making a meaningful impact on healthcare affordability and quality, this is your opportunity to make a difference for our members and providers. This role offers a unique chance to influence strategy, develop new policies, and collaborate with a team that truly values both coding expertise and payment integrity excellence . Benefits: Be a founding member of a newly created Payment Integrity department Play a key role in building and implementing new policies and processes Collaborate with a team that respects and values your coding and payment integrity expertise Access professional development opportunities to support your long-term growth Starting pay range based upon skills and experience: $71,000 to $88,800 + robust benefits package

Requirements

• Bachelor’s degree with 2 years of Payment Integrity, Coding Integrity, or Revenue Integrity Experience
• Or Associate’s degree with 5 years of Experience
• Or High School equivalency with 8 years of Experience
• Completion of a Medical Coding Program
• Certifications in CPC, COC, RHIT, RHIA, CCA, and/or CCS
• Intermediate to Advanced knowledge in Business Objects and Excel
• Strong Understanding of: CMS and Commercial Payer Policies Claims Processing and Reimbursement ICD-10 Coding & DRG Validation Healthcare Revenue Cycle Operations
• Confidence engaging with providers, including discussions at the executive level
• Hardware and equipment will be provided by the company, but candidates must have access to high-speed, non-satellite Internet to successfully work from home.

Responsibilities

• Investigate, analyze, develop and implement Payment Integrity Policies
• Research National, Regional, and Local health plans Payment Integrity practices to identify industry trends
• Analyze financial performance of Quartz, provider sponsors, and risk pools
• Reviews, analyzes, and responds to internal or external audits related to Payment Integrity Policies
• Monitor regulatory compliance related to federal, state and ERISA regulations
• Develop provider appeal responses in collaboration with Provider Network Management
• Create educational materials to support provider understanding of Payment Integrity Policies
• Review and respond to escalated provider appeals
• Drive process improvements related to provider abrasion and payment integrity workflows

Benefits

• Be a founding member of a newly created Payment Integrity department
• Play a key role in building and implementing new policies and processes
• Collaborate with a team that respects and values your coding and payment integrity expertise
• Access professional development opportunities to support your long-term growth
• Starting pay range based upon skills and experience: $71,000 to $88,800 + robust benefits package

What This Job Offers

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