Payments Integrity & Recovery Analyst (Remote)

CareOregon, Inc.; Oregon (WI); Hybrid; USD 90,922,000 - 111,586,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Retirement plan

Paid time off

Job summary

CareOregon, Inc. is seeking a Payment Integrity Analyst to execute claims investigations and recovery strategies. You will analyze claims data, identify cost containment opportunities, and conduct audits to ensure proper claim payments.

The role involves collaborating with Clinical, Contracting, Finance, Claims, and Provider Relations to align efforts and support all recovery activities. A strong emphasis on analytics, fraud prevention, and process improvement is required.

Qualifications

• 3+ years’ experience with Medicare/Medicaid claims systems.
• 1+ year’ experience performing advanced claims adjustments.
• 2 years of QNXT experience preferred.

Responsibilities

• Implement new Payment Integrity initiatives as directed by the Manager/Director.
• Collaborate with Claims teams to maximize efficiency and knowledge sharing.
• Review CMS/RAC topics for viability of paid claims and advise on recoveries.

Skills

Claims processing

Analytical skills

Communication

Excel

Tools

SQL Server

Tableau

QNXT

Job description

CareOregon, Inc. is seeking a Payment Integrity Analyst to execute claims investigations and recovery strategies. You will analyze claims data, identify cost containment opportunities, and conduct audits to ensure proper claim payments.

The role involves collaborating with Clinical, Contracting, Finance, Claims, and Provider Relations to align efforts and support all recovery activities. A strong emphasis on analytics, fraud prevention, and process improvement is required.