Business Analyst, Consultant

Your Role

The Payment Integrity team is responsible for ensuring healthcare claims are paid accurately, both in a pre-pay and post-pay context. Some examples of payment integrity include validating coding rules, determining the correct party, membership eligibility, contractual adherence, and conducting root cause analysis to prevent errors. This team is responsible for over $400M+ of cost of healthcare savings and avoidance annually and is also responsible for developing new capabilities to improve cost of healthcare exposure and performance, managing multiple third-party partners in pursuit and prevention of over-payments. The Business Analyst Consultant of Payment Integrity will report to the Director of Payment Integrity. In this role you will collaborate with various internal teams and vendors to improve cost of healthcare and premium cost outcomes.

Your Knowledge and Experience

• Requires a bachelor's degree or equivalent experience
• Requires at least 7 years of prior relevant experience
• In depth experience with payment integrity practices and related operations preferred
• Possess strong data/analytic, financial, and process experience
• Familiarity with medical claim coding standards and concepts
• SQL expertise desired
• FACETS claim processing system experience desired