Payment Integrity Analyst III
3 months ago
Salary Range: $77,265.00 (Min.) - $100,445.00 (Mid.) - $123,625.00 (Max.)
Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members we make sure our members get the right care at the right place at the right time.
Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
The Payment Integrity Analyst III is responsible for leading or assisting in vendor implementations and configuration, algorithm/edit customizations, overpayment remediation, as well as other Payment Integrity functions. The position is also responsible for supporting Payment Integrity solutions focused on trending overpayment and refund reasons to identify and fully develop pipeline of new Payment Integrity initiatives. These initiatives include additional overpayment project pipeline as well as development of cost avoidance practices. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.
DutiesServes as vendor oversight monitoring to ensure proper submission of files and correct invoicing as well as monitoring QA metrics to meet all vendor estimates. Serves as SME for all Payment Integrity functions to include both Retrospective Data Mining as well as Pre-Payment cost avoidance.
Supports the creation and execution of strategies that determine impact of opportunity and recover overpayments as well as prospective internal controls preventing future overpayments of each applicable pipeline opportunity. Works with both internal and external groups to define and develop cost avoidance measures to ensure continued success.
Fields and responds to escalated requests (including research) for all inquiries both internal and external; Fields and responds to Provider Dispute Resolution (PDR) requests stemming from Payment Integrity activities; supports correspondence in identification of trends for overpayment opportunities resulting in future pipeline activity.
Identifies and defines Payment Integrity issues and reviews and analyzes evidence, utilizes data for the purpose of verifying errors and identifying systemic errors, works as an active team member during scheduled engagements and work collaboratively to achieve the goals of the team, and provides feedback to the team lead on any issues identified during research or claims review.
Serves as a subject matter expert and leads and/or assists in algorithm/edit customizations, as well as all vendor implementations as needed. Applies subject expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the project’s/program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed.
Performs other duties as assigned.
Duties Continued Education Required Bachelor's DegreeIn lieu of degree, equivalent education and/or experience may be considered.Education Preferred ExperienceRequired:
At least 3 years of experience in Cost Avoidance and/or Coordination of Benefits or in Payment Integrity.
At least 5 years participating in healthcare (Medicare, Medicaid, Commercial).
At least 5 years of experience with health care data.
Experience in project implementation.
SkillsRequired:
Knowledge in CPT, HCPCS, ICD-9, ICD-10, Medicare, and Medicaid rules and regulations.
Working knowledge of claims coding and medical terminology. Solid understanding of standard claims processing systems and claims data analysis.
Strong project leadership and management skills required; ability to prioritize, plan, and handle multiple tasks/demands simultaneously.
Expert knowledge of healthcare reimbursement concepts.
Excellent interpersonal, verbal, and written communication skills required with excellent analytical and problem-solving skills.
Must be collaborative ability to establish credibility quickly with all levels of management across multiple functional areas.
Must be able to present findings across all departments.
Must be familiar with coordinating benefits between health plan payers.
Advanced knowledge of Microsoft Office suite, including Word, Excel and PowerPoint.
Licenses/Certifications Required Licenses/Certifications Preferred Required Training Physical Requirements LightAdditional InformationSalary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
This position is a limited duration position. The term of this position is a minimum one year and maximum of two years from the start date unless terminated earlier by either party. Limited duration positions are full-time positions and are eligible to receive full benefits.
L.A. Care offers a wide range of benefits including
- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
- Volunteer Time Off (VTO)
-
Business Analyst III
2 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeJob SummaryThe Business Analyst III plays a crucial role in facilitating business process improvement by methodically investigating, analyzing, and documenting functional business specifications. This position manages the requirements development process, ensuring the elicitation, analysis, specification, and verification of multiple levels of requirements...
-
Payment Operations Manager
4 weeks ago
Los Angeles, California, United States iNtegrity+ Full timeJob Title: Payment Operations ManageriNtegrity+ is seeking a highly skilled Payment Operations Manager to join our team. As a key member of our payments team, you will be responsible for building and managing relationships with card brands, sponsor banks, and settlement platforms.Responsibilities:Implement BINs and ICAs and manage relationships with...
-
Application Analyst III
1 month ago
Los Angeles, California, United States Central California Alliance for Health Full timeAbout the RoleWe are seeking an experienced Application Analyst III to join our Application Services Department. As a key member of our team, you will provide medium- to high-level support and expertise related to systems configuration, research, and analysis, in support of the Application Analyst IV.Key ResponsibilitiesProvide technical support and...
-
Business Analyst III
4 months ago
Los Angeles, United States L.A. Care Health Plan Full timeSalary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million...
-
Rocket Engines Structural Analyst III
2 weeks ago
Los Angeles, California, United States Blue Origin Full timeJob DescriptionAt Blue Origin, we're pushing the boundaries of space exploration and development. As a Structural Analyst III for Rocket Engines, you'll play a critical role in designing and developing the next generation of rocket engines and propulsion systems.This is a unique opportunity to join a dynamic team of engineers and contribute to the...
-
Portfolio Credit Analyst III
2 weeks ago
Los Angeles, California, United States City National Bank Full timeJob Title: Portfolio Credit Analyst IIIAt City National Bank, we're looking for a skilled Portfolio Credit Analyst III to join our team. As a key member of our credit portfolio management team, you'll be responsible for designing and generating reports to support credit portfolio management, as well as maintaining a database reporting system to accommodate...
-
Turbomachinery Structural Analyst III
2 weeks ago
Los Angeles, California, United States Blue Origin Full timeAbout the RoleAt Blue Origin, we're pushing the boundaries of space exploration and development. As a Turbomachinery Structural Analyst III, you'll play a critical role in designing and analyzing the structural integrity of our turbomachinery systems.Key ResponsibilitiesPerform structural analysis and design of turbomachinery components using FEA and...
-
Portfolio Credit Analyst III
1 week ago
Los Angeles, California, United States City National Bank Full timeJob Title: Portfolio Credit Analyst IIICity National Bank is seeking a highly skilled Portfolio Credit Analyst III to join our team. As a key member of our credit portfolio management team, you will be responsible for designing and generating monthly, quarterly, and ad hoc reports to support credit portfolio management.Key Responsibilities:Design and...
-
Financial Analyst II/III
5 days ago
Los Angeles, California, United States The National Renewable Energy Laboratory (NREL) Full timeJob SummaryThe National Renewable Energy Laboratory (NREL) is seeking a highly skilled Financial Analyst II/III to join our team. As a key member of our financial management team, you will provide financial management support to the Chief Financial Officer and other laboratory business leaders, program managers, project managers, and other NREL staff.Key...
-
Portfolio Analyst Credit III
2 weeks ago
Los Angeles, California, United States City National Bank Full timeJob Title: Portfolio Analyst Credit IIIAt City National Bank, we're seeking a highly skilled Portfolio Analyst Credit III to join our team. As a key member of our credit portfolio management team, you will be responsible for designing and generating monthly, quarterly, and ad hoc reports to support credit portfolio management.Key Responsibilities:Design and...
-
Portfolio Analyst Credit III
2 weeks ago
Los Angeles, California, United States City National Bank Full timeJob Title: Portfolio Analyst Credit IIIAt City National Bank, we're seeking a highly skilled Portfolio Analyst Credit III to join our team. As a key member of our credit portfolio management team, you will be responsible for designing and generating monthly, quarterly, and ad hoc reports to support credit portfolio management.Key Responsibilities:Design and...
-
Portfolio Analyst Credit III
4 weeks ago
Los Angeles, California, United States City National Bank Full timeJob Title: Portfolio Analyst Credit IIIAt City National Bank, we're seeking a highly skilled Portfolio Analyst Credit III to join our team. As a key member of our credit portfolio management team, you will be responsible for designing and generating reports to support credit portfolio management, maintaining a database reporting system, and anticipating...
-
Tax Analyst III
1 week ago
Los Angeles, California, United States Kaiser Permanente Full timeJob Summary:As a Tax Analyst III at Kaiser Permanente, you will play a critical role in preparing and reviewing tax returns and reports related to federal, state, local, property, sales, and other tax liabilities. This position requires maintaining current knowledge of tax laws affecting the company and assisting in the review of proposals for tax...
-
Tax Analyst III
2 weeks ago
Los Angeles, California, United States Kaiser Permanente Full timeJob Summary:We are seeking a highly skilled Tax Analyst III to join our team at Kaiser Permanente. This role will be responsible for preparing and reviewing tax returns and reports related to federal, state, local, property, sales, and other tax liabilities. The successful candidate will also perform tax research and resolve federal and state tax notices,...
-
Public Utilities Regulatory Analyst III
1 month ago
Los Angeles, California, United States Public Utilities Commission Full timeJob Description and DutiesAs a Public Utilities Regulatory Analyst III, you will assist high-level decision makers in evaluating competing policy proposals for Tariff Rules 21, 15, 16, and 2. You will analyze regulatory, policy, and technical issues to make recommendations that support safety, reliability, and state climate goals.Key...
-
Health Informatics Analyst III
1 week ago
Los Angeles, California, United States University of California Full timeThe Health Informatics Analyst III plays a pivotal role in transforming data into actionable insights at UCLA Health and Health Sciences. In this position, you will gather business needs, document requirements, and organize complex clinical, financial, and operational data from multiple sources using standard programming languages. Your work will culminate...
-
Business Insights Data Analyst III
5 days ago
Los Angeles, California, United States L.A. Care Health Plan Full timeJob Summary:The Business Insights Data Analyst III is a key contributor responsible for supporting short and long-term operational and/or strategic business initiatives in the healthcare sector. This position navigates the complexities of healthcare data, encouraging a dynamic and innovative mindset that emphasizes thinking outside the box. Independently,...
-
Senior Software Engineer with Payment Systems
2 weeks ago
Los Angeles, California, United States eTek IT Services, Inc. Full timeJob Title: Senior Software Engineer with Payment SystemsAs a Senior Software Engineer with Payment Systems, you will be responsible for designing, writing, testing, implementing, and documenting solutions for assigned programs and applications across the organization.Key Responsibilities:Design, write, test, implement, and document solutions for assigned...
-
Product Manager
1 week ago
Los Angeles, California, United States Lightspark Full timeProduct Manager - PaymentsLightspark is revolutionizing the way money moves on the Internet. As a Product Manager - Payments, you will be responsible for overseeing the development and scale of our payment products. You'll work closely with cross-functional teams to ensure that our payment solutions meet the needs of our customers and align with the...
-
Business Intelligence Analyst III
4 days ago
Los Angeles, California, United States Vets Hired Full timeJob DescriptionAt Vets Hired, we leverage advanced information technology to enhance patient care and experiences. As a Business Intelligence Analyst III, you will play a vital role in developing our technological capabilities.This role involves providing advanced data and analytical support to our health system. Responsibilities include:Developing and...
