Remote Payment Integrity Analyst - Claims & Recoveries

CareOregon; Oregon (WI); On-site; USD 67,000 - 82,000; Full time

Benefits offered by this job

Bonus opportunity

Benefits package

Retirement plan

Work from home

Job summary

CareOregon is seeking a Payment Integrity Analyst to execute claims investigation and recovery strategies. You will analyze claims data to identify cost containment opportunities and conduct audits across multiple claims areas to ensure proper payments.

You will collaborate with Clinical, Contracting, Finance and Provider Relations to align efforts and support all recovery activities. The role requires experience with Medicare/Medicaid claims systems, strong analytical skills, and the ability to

Qualifications

• Experience with Medicare/Medicaid claims systems and auditing.
• Proficient in identifying cost containment opportunities.
• Strong analytical and problem-solving abilities.
• Ability to explain findings clearly to stakeholders.

Responsibilities

• Execute claims investigation and recovery strategies.
• Audit simple to complex claims payments and identify overpayments.
• Collaborate with internal teams (Clinical, Contracting, Finance).
• Enter recovery information and prepare overpayment notices.
• Support testing and resolve payment disputes as needed.

Skills

Medicare/Medicaid claims systems

Advanced claims adjustments

Regulatory knowledge (CMS/RAC)

Analytical problem solving

Communication skills

Excel proficiency

Tools

SQL Server Reporting

Tableau

Job description

CareOregon is seeking a Payment Integrity Analyst to execute claims investigation and recovery strategies. You will analyze claims data to identify cost containment opportunities and conduct audits across multiple claims areas to ensure proper payments.

You will collaborate with Clinical, Contracting, Finance and Provider Relations to align efforts and support all recovery activities. The role requires experience with Medicare/Medicaid claims systems, strong analytical skills, and the ability to