Payment Integrity Analyst

7 days ago

Manhattan, United States Tandym Group Full time $80,000 - $86,000

A health services network in New York City is currently seeking a new Payment Integrity Analyst for a promising opportunity with their growing team. In this role, the Payment Integrity Analyst will be responsible for assisting in the development of a strategic roadmap to recover, eliminate, and prevent unnecessary medical-expense spending and support the execution for a comprehensive claim accuracy program.

**This is a hybrid position with 2 days in the office and 3 days remote.

Responsibilities:

The Payment Integrity Analyst will:

  • Assist in the development a stellar payment integrity unit capable of proactively identifying and investigating payment issues and working with stakeholders to develop mitigation strategies to prevent future occurrences, with the ability to review impacts holistically
  • Assist in the development of a comprehensive, strategic roadmap to recover, eliminate, and prevent unnecessary medical-expense spending by reviewing upstream and downstream processes
  • 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
  • Assist in the development and deployment of mitigation strategies to avoid future overpayments, driving incremental value year over year in both medical and administrative cost savings
  • Manage the day-to-day financial recovery vendor relationships, validating that identified overpayments are valid and recouped
  • Assist in the development and implementation of dashboards to monitor performance
  • Complete and analyze trending reports to identify favorable/unfavorable trends
  • Analyze departmental performance trends and assist with identifying new opportunities to streamline processes and improve performance of key metrics
  • Assist in developing and maintaining payment integrity policies and procedures
  • Perform other duties, as needed

Qualifications:

  • 5+ years of Claims experience in the Healthcare and/or Insurance industry
  • Bachelor's Degree
  • Extensive knowledge of healthcare provider audit methods and provider payment methods, clinical aspects of patient care, medical terminology, and medical record/billing documentation
  • Proven ability to apply Quantitative and/or Qualitative Research and Data Analysis techniques to improve operational processes.
  • Familiar with Claim Coding practices and industry issues in Medicare Payment methodologies.
  • Microsoft Excel proficient

  • Investment Banking Analyst

    1 week ago

    Manhattan, United States Selby Jennings Full time

    **Investment Banking Industrials Analyst - New York, NY**This client is an Investment Bank seeking a diligent and results-driven Investment Banking Analyst to join their industrials team in New York City. This is your chance to play an integral role within a prestigious investment banking sector where you will be at the heart of critical capital raises,...

  • Private Credit Analyst/Associate

    3 months ago

    Manhattan, United States Selby Jennings Full time

    A a leading global investment firm is looking to add a Private Credit Analyst or Associate to the Credit Solutions Group in New York, NY. The firm aims to generate attractive investment returns by following a patient and disciplined investment approach, employing world-class people, and supporting growth in its portfolio companies and communities. The...

  • Investment Banking Analyst/Associate

    2 months ago

    Manhattan, United States eFinancialCareers Full time

    Our client is a leading global investment bank specializing in providing strategic advisory services to clients facing complex financial challenges. They are seeking a highly motivated and experienced Analyst to join their Restructuring and Special Situations Investment Banking team. The ideal candidate will have a strong background in financial analysis,...

  • GenAI Technical Analyst

    1 month ago

    manhattan beach, United States Skechers Full time

    Skechers is enabling our business with AI through the development and adoption of private, proprietary AI technologies. The GenAI Technical Analyst & Functional Lead is a key role within the Software Engineering and Architecture organization and will be central to continually developing and improving our Generative AI platform and technologies within...

  • GenAI Technical Analyst

    2 months ago

    Manhattan Beach, United States Skechers Full time

    Skechers is enabling our business with AI through the development and adoption of private, proprietary AI technologies. The GenAI Technical Analyst & Functional Lead is a key role within the Software Engineering and Architecture organization and will be central to continually developing and improving our Generative AI platform and technologies within...

  • CT / Cath Lab Technologist Cardiac Cath Lab in Manhattan, KS

    3 weeks ago

    Manhattan, United States Ardor Health Solutions Full time

    Description: Estimated payment breakdown $3,008 per week in taxable pay and non-taxable stipends Specialty: CT Start Date: 1/19/2025 Duration: 13 40 hours per week Shift: 4x10 Days Employment Type: Traveler Ardor Health Solutions is looking for a Cath Lab Technologist to join our travel team in a Hospital setting, in Manhattan, KS! This is a full time...

  • Recruitment Sales

    7 days ago

    Manhattan, United States Oliver James Full time $55,000

    Job description Reach your recruitment potential with Oliver James The best entry level recruitment opportunity in NYC! 12 weeks of comprehensive, hands on, individualized training included Recruiting into incredibly lucrative markets (Banking, Finance, Insurance) Work alongside some of the top billers in the industry Global, growing &...

  • Recruitment Sales

    7 days ago

    Manhattan, United States Oliver James Full time $55,000

    Job description Reach your recruitment potential with Oliver James The best entry level recruitment opportunity in NYC! 12 weeks of comprehensive, hands on, individualized training included Recruiting into incredibly lucrative markets (Banking, Finance, Insurance) Work alongside some of the top billers in the industry Global, growing &...

  • Salesforce Architect

    8 hours ago

    Manhattan, United States Ness Digital Engineering Full time

    Ness is a full lifecycle digital engineering firm offering digital advisory through scaled engineering services. Combining our core competence in engineering with the latest in digital strategy and technology, we seamlessly manage Digital Transformation journeys from strategy through execution to help businesses thrive in the digital economy. As your tech...

  • Member Service Representative I

    3 months ago

    Manhattan, United States Farm Bureau Financial Services Full time

    Member Service Representative I Are you looking to start your career at a place that cares about its employees and invests in you through continued training and education? Do you thrive on teamwork and want to experience professional satisfaction and growth at an insurance organization that’s focused on Protecting Livelihoods and Future? Are you...

  • GenAI Technical Analyst

    1 month ago

    new york city (manhattan beach), United States Skechers Full time

    Skechers is enabling our business with AI through the development and adoption of private, proprietary AI technologies. The GenAI Technical Analyst & Functional Lead is a key role within the Software Engineering and Architecture organization and will be central to continually developing and improving our Generative AI platform and technologies within...

  • Facilities Systems Manager

    7 days ago

    Manhattan, United States NewYork-Presbyterian Hospital Full time $97,000 - $145,000

    The Manager is responsible for overseeing and maintaining facility management systems that support the Facilities and Real Estate Department, ensuring the smooth operation of critical business systems, including but not limited to the project management information system (Oracle’s Unifier platform), integrations (ETLs), and various reporting tools...

  • Facilities Systems Manager

    7 days ago

    Manhattan, United States NewYork-Presbyterian Hospital Full time $97,000 - $145,000

    The Manager is responsible for overseeing and maintaining facility management systems that support the Facilities and Real Estate Department, ensuring the smooth operation of critical business systems, including but not limited to the project management information system (Oracle’s Unifier platform), integrations (ETLs), and various reporting tools...

  • Delivery Assistant

    2 months ago

    Manhattan, United States Best Buy Full time

    Job Description As a Delivery Assistant, you'll join us during our busy holiday season to accompany a team of seasoned Agents to customers' homes. In this role, you'll assist with the delivery, installation, repair and haul-away of electronic devices. You'll also support your team by performing duties such as integration and networking. Internally, this role...

  • Credit eTrading Quantitative Researcher

    2 weeks ago

    Manhattan, United States Selby Jennings Full time

    Role: Credit eTrading Quantitative Researcher (VP) Firm: Tier 1 US Investment Bank Compensation: $350K-$400K total compensation Location: New York Role Overview A leading Tier 1 US Investment Bank is seeking to expand its Global Credit E-Trading business, a premier provider of market-making services in bonds, credit derivatives, and structured financial...

  • Wealth Management Advisor

    2 months ago

    manhattan beach, United States Northwestern Mutual Full time

    Unlimited Impact, Uncapped Income and IndependenceFinancial Advisors at Northwestern Mutual help their clients live more and worry less through our personalized approach to financial planning. As a business owner, they spend their days acquiring clientele and finding financial solutions with help from our industry-leading training, mentors, and products....

  • Wealth Management Advisor

    2 months ago

    Manhattan Beach, United States Northwestern Mutual Full time

    Unlimited Impact, Uncapped Income and IndependenceFinancial Advisors at Northwestern Mutual help their clients live more and worry less through our personalized approach to financial planning. As a business owner, they spend their days acquiring clientele and finding financial solutions with help from our industry-leading training, mentors, and products....

  • Wealth Management Advisor

    2 months ago

    new york city (manhattan beach), United States Northwestern Mutual Full time

    Unlimited Impact, Uncapped Income and IndependenceFinancial Advisors at Northwestern Mutual help their clients live more and worry less through our personalized approach to financial planning. As a business owner, they spend their days acquiring clientele and finding financial solutions with help from our industry-leading training, mentors, and products....

  • WMS (Manhattan) Tester

    1 month ago

    new york city (manhattan), United States Tata Technologies Full time

    At Tata Technologies we make product development dreams a reality by designing, engineering, and validating the products of tomorrow for the world’s leading manufacturers. Due to our continued growth, we are now recruiting for a WMS (Manhattan) Tester to strengthen our team in Lisle IL.WMS (Manhattan) TesterLisle ILJob Summary:The WMS (Manhattan) Tester...