Healthcare Payment Integrity Analyst

2 days ago


New York, New York, United States Innova solutions Full time
Job Description:
Innova Solutions seeks a skilled Healthcare Payment Integrity Analyst to join our team in NYC. This role is responsible for proactively identifying and investigating payment issues, developing mitigation strategies, and reviewing upstream and downstream processes. The ideal candidate will have extensive knowledge of healthcare provider audit methods, clinical aspects of patient care, and medical terminology.

The estimated salary for this position is around $110,000 per year, based on the job requirements and location.

Responsibilities:
  • Assist in the development of a comprehensive strategic roadmap to recover, eliminate, and prevent unnecessary medical-expense spending.
  • Identify overpayment/underpayment opportunities by data mining, investigation, and quality review on benefit and/or provider configuration, rate loads, rate assignments, COB, claims payment logic, etc.
  • Support the execution and maintenance of a corporate claim accuracy program by optimizing pre/post claim editing, auditing, and claim recovery programs.


Requirements:
A minimum of 5 years' working experience within claims in the healthcare or insurance industry, Advance level experience with Excel, and MS SQL, and other data systems are required. A Bachelor's degree is also mandatory.

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