Responsible for operationalizing business and/or regulatory requirements, including payment integrity process improvement and work related for developing prospective claims editing while utilizing clinical coding and reimbursement policies.
Must be subject matter expert in Payment Integrity vendor relationships.
This role will drive planning and execution of initiatives related to Payment Integrity Growth and Optimization. They will be highly engaged and aligned with the Payment Integrity vendors and all related internal teams and external vendor partners.
The incumbent has detailed expertise around the lifecycle of a claim and how Payment Integrity affects adjudication. In addition, they will be able to create new prospective edits and analyze existing edits to cultivate a robust Payment Integrity offering. They will be responsible for compiling, collecting, analyzing, reporting and presenting product data to various stakeholders.
Skills and Abilities:
Minimum Qualifications:
The full salary range for this position is $61,500-$105,400. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.
The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.
We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.
Operations Operational Analyst IV • Minnetonka, MN, United States
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