Lead Analyst, Payment Integrity

A company is looking for a Lead Analyst, Payment Integrity.

Key Responsibilities

Assist in executing tasks to meet regulatory requirements and improve operational outcomes related to Payment Integrity

Manage Scorable Action Items to ensure health plan targets are met and improve claim payment accuracy

Collaborate with various teams to identify issues and implement resolution strategies while providing recommendations to health plan leadership

Required Qualifications

At least 6 years of experience as a Business Analyst or Program Manager in a Managed Care Organization or health plan setting

Proven experience in managing operational projects related to provider reimbursement and claims payment integrity

Strong knowledge of managed care claims coding and federal / state Medicaid payment rules

Skilled in Excel and SQL for data analysis to inform business decisions

Demonstrated ability to work independently in a highly regulated environment