Reimbursement Policy & Claims Integrity Analyst

HealthPartners; BLOOMINGTON (MN); Sur place; USD 90 000 - 120 000; Plein temps

Résumé du poste

HealthPartners is seeking a Payment Integrity Reimbursement Policy Analyst to develop, maintain, and govern reimbursement policies supporting accurate claims adjudication across professional and facility services.

The role collaborates with Claims Operations, Medical Policy, Compliance, Legal, IT, and Payment Integrity to design, monitor, and optimize policies that promote payment accuracy, regulatory compliance, and provider transparency.

Qualifications

• Bachelor's degree in a related field is required.
• Experience with HMO, fully insured, indemnity, and government programs is required.
• Prior experience in medical claims processing and adjudication is preferred.

Responsabilités

• Reimbursement policy development for professional, facility, laboratory, pharmacy, and ancillary healthcare services.
• Interpret and apply Medicare, Medicaid, commercial payer, and industry reimbursement requirements.
• Evaluate coding and reimbursement issues involving CPT, HCPCS Level II, ICD-10-CM, ICD-10-PCS, DRG, APC, and revenue code methodologies.
• Draft clear policy language for provider-facing reimbursement policy documents.
• Ensure policies align with organizational objectives, provider contracts, benefit administration requirements, and applicable regulations.

Connaissances

Claims adjudication

Coding knowledge

Policy development

Data analysis

Communication

Excel proficiency

Formation

Bachelor's degree in Healthcare Administration

Outils

Coding software platforms

System editing tools

Description du poste

HealthPartners is seeking a Payment Integrity Reimbursement Policy Analyst to develop, maintain, and govern reimbursement policies supporting accurate claims adjudication across professional and facility services.

The role collaborates with Claims Operations, Medical Policy, Compliance, Legal, IT, and Payment Integrity to design, monitor, and optimize policies that promote payment accuracy, regulatory compliance, and provider transparency.