Payment Integrity Value Oversight Analyst

Payment Integrity Analyst

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. Facilitate 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

Comprehensive benefits package to meet your financial, health, and work / life balance goals.

On-demand pay program powered by Payactiv

Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!

Optional identity theft protection, home and auto insurance, pet insurance

Traditional and Roth retirement options with service contribution and match savings

Eligibility for benefits is determined by employment type and status

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