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Reporting to the Associate Director of Professional Reimbursement Strategy, the Payment Integrity Reimbursement Policy Quality Assurance (QA) Analyst is responsible for completing invoice and reconciliation claim audits for BCBSMA's payment integrity programs. Quality assurance audit reviews and core functions include reconciling vendor invoiced claims against finalized paid claims to identify and document payment discrepancies, root cause analysis to reduce errors, streamline audits, manage invoice database, interacting with stakeholders and producing reports for the programs. The Payment Integrity Reimbursement Policy Quality Assurance (QA) Analyst would also be responsible for payment & reimbursement policy support including policy research & development, clinical editing, industry regulatory coding knowledge, business operations and acting as a subject matter expert (SME).
