Payment Integrity & Reimbursement Analyst - Full-time

Avera Health • Sioux Falls, SD

443d • $59,800 - $90,480

About The Position

The Payment Integrity & Reimbursement Analyst at Avera Health Plans is responsible for enhancing claim outcomes across various product lines within the Network Services organization. This role involves collaborating with cross-functional teams to develop and implement project strategies, monitor progress, and optimize processes to improve claim accuracy and reduce unnecessary medical expenses. The analyst will also serve as a subject matter expert, mentor staff, and maintain performance reports and dashboards.

Requirements

• Bachelor's degree required; Master's degree preferred.
• Minimum of five (5) years of progressive experience in the health care industry.
• Minimum of three (3) years of applicable experience in Payment Integrity and Reimbursement.
• Minimum of five (5) years of applicable experience with health insurance preferred.

Responsibilities

• Oversee and manage the enhancement of claim outcomes across existing and emerging product lines.
• Collaborate with cross-functional teams to devise and implement project strategies.
• Mitigate risks and monitor progress of projects.
• Lead process optimization efforts to create transformative change.
• Assist in developing a strategic roadmap to recover and prevent unnecessary medical expenses.
• Support execution of a comprehensive claim accuracy program.
• Maintain network KPI reports and performance dashboards.
• Assist in provider training, orientation, and coaching for performance improvement.
• Employ analytics and trends to identify savings opportunities and develop mitigation strategies.

Benefits

• Health insurance
• Opportunities for advancement
• Paid time off

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Hospitals
• Education Level: Bachelor's degree