Research Analyst - Medical Management, Remote

Providence•Portland, OR

1d•Remote

About The Position

Under the direction of the Head of Providence Health Plan (PHP) Payment Integrity (PI), the Research and Development (R&D) Analyst is responsible for identifying, developing, and implementing solutions to improve the accuracy and integrity of claims payments across the Plan. This role focuses on preventing and reducing unnecessary spending by scoping PI initiatives, analyzing claims data, developing a thorough implementation assessment plan, and collaborating with internal and external stakeholders to optimize the payment processes. This is accomplished by leveraging a deep understanding of Providence Health Plan infrastructure, claims edit and processing platforms, Plan policy, regulatory/compliance, benefit, and contracting functions to synthesize meaningful and actionable PI initiative recommendations. Providence Health Plan caregivers are not simply valued – they’re invaluable. Join our team at Providence Health Plan Partners and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them. This role offers 100% remote work for candidates residing in: Oregon Washington California

Requirements

Bachelor's Degree, or 3 years equivalent experience.
3 years experience with performance improvement/organizational change tools.
3 years experience working with large data sets and analytics teams.
3 years claims processing experience within the health insurance industry.
Experience with reimbursement methodologies, including the Centers for Medicare & Medicaid Services (CMS), provider contracts, and medical coding practices.
Healthcare experience in project coordination encompassing operations analysis, outcomes measurement methodology, data management and quality improvement process design.

Responsibilities

Identifying, developing, and implementing solutions to improve the accuracy and integrity of claims payments.
Scoping PI initiatives, analyzing claims data, and developing implementation assessment plans.
Collaborating with internal and external stakeholders to optimize payment processes.
Leveraging understanding of Providence Health Plan infrastructure, claims edit and processing platforms, Plan policy, regulatory/compliance, benefit, and contracting functions to synthesize PI initiative recommendations.