Payment Integrity Value Oversight Analyst

Job Summary

Drives the successful performance of Payment Integrity initiatives by evaluating the financial and operational performance of Payment Integrity results. Works with vendors and other key business areas to address the effectiveness of overpayment prevention solutions and identify potential solution enhancements as necessary. Under minimal supervision and collaborating across multiple teams, inspects payment integrity results, selection criteria, and claim universe while adhering to organizational, departmental, team and governmental standards and regulations. Performs financial, business, and workflow analysis to improve Payment Integrity processes. Supports the design of self-service reporting assets to provide data exploration capabilities to end users. Participates in providing operational support for systems and applications, troubleshooting and maintenance, and ad-hoc support for incidents related to data warehouses, data sets and data pipelines. Works with more experienced team members to capture, document and groom features and stories for Agile scrum teams. Team members in this position are competent to work self-sufficiently in most activities but require instruction or guidance in others.

Essential Functions

• Performs statistical, cost, and financial variance analysis of data to evaluate financial performance and identify improvement opportunities. Includes development of forecast models and retrospective assessment of appeals and other adjustments.
• Ensures data used in deliverables is both complete and accurate. Facilitates sharing of payment integrity analysis with multiple stakeholder groups, including internal committees, regulatory agencies, vendors, and providers.
• Presents findings to leadership in a manner that convincingly facilitates problem solving and decision making.
• Participates in communications with data consumers with a skill growth mindset, to improve performance of processes connecting to data, and shares best practices.
• Develops relationships and collaboration across multiple teams to deliver timely and reliable information that enables users to uncover insight from information.
• Participates in data cleansing and profiling to ensure accuracy and quality of information.
• Applies the organizational standards and laws governing use of sensitive data relating to Protected Health Information and Personally Identifiable Information.
• Performs business analysis and workflow analysis in partnership with data consumers to improve performance of Payment Integrity processes connecting to data.
• Pursues opportunities to grow their business acumen and skills from more experienced team members. Provides coaching to less experienced team members.

Qualifications

Required

Preferred

About Corewell Health

As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

How Corewell Health cares for you

Primary Location

SITE - Priority Health Conference Center - 3111 Leonard NE - Grand Rapids

Department Name

PH - Payment Integrity - Value and Analysis

Employment Type

Full time

Shift

Day (United States of America)

Weekly Scheduled Hours

40

Hours of Work

8 : 00 a.m. to 5 : 00 p.m.

Days Worked

Monday to Friday

Weekend Frequency

N / A

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Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.486.7447.