Senior Payment Integrity Lead - Remote & Data-Driven

Remote Jobs; United States; Remote; USD 91,000 - 121,000; Full time

Benefits offered by this job

Competitive salary

Medical Insurance with Dental and VIsn

Life insurance options

Career advancement opportunities

Wellness programs

Flexible Spending Account

CalPERS retirement

Paid life insurance

Pet care insurance

Job summary

IEHP is seeking a Senior Payment Integrity Analyst to provide lead-level analyst support, ensuring the accuracy of vendor payments and internal operations. This role involves collaboration with leaders to enhance health plan performance through payment integrity initiatives.

The successful candidate will have extensive experience in claims auditing, strong data analysis skills, and the ability to mentor junior analysts.

Qualifications

• Minimum of five years of experience in payment integrity, claims auditing, and/or medical coding.
• Strong data analysis/queries experience.
• Experience with contract and Division of Financial Responsibility (DOFR) interpretation.

Responsibilities

• Lead efforts to improve claim payment accuracy.
• Develop complex audit data mining techniques.
• Work with providers to resolve payment discrepancies.
• Conduct comprehensive reviews of claims.
• Provide training and QC support to junior analysts.
• Oversee vendor audit pipelines.
• Interpret and apply federal/state regulations.
• Collaborate in the development of new audit concepts.
• Analyze and resolve provider inquiries and appeals.

Skills

Data analysis

Payment integrity

Medical coding

SQL proficiency

Communication skills

Education

Bachelor's degree in business or health administration

RHIA, RHIT, CCS, CPC, CIC certification

Tools

SQL

MS Excel

Data visualization tools

Job description

IEHP is seeking a Senior Payment Integrity Analyst to provide lead-level analyst support, ensuring the accuracy of vendor payments and internal operations. This role involves collaboration with leaders to enhance health plan performance through payment integrity initiatives.

The successful candidate will have extensive experience in claims auditing, strong data analysis skills, and the ability to mentor junior analysts.