Program Integrity Recovery Analyst

2 days ago

Newtown Square, PA, United States AmeriHealth Caritas Full time
Role Overview:

As part of the Program Integrity recovery team, the Program Integrity Analyst I is responsible for managing overpayment recovery Projects through parts of the lifecycle for larger Projects and through the full lifecycle for smaller Projects. This position will require working closely with ACFC plans and external Program Integrity vendors to ensure that recovery opportunities result in realized recoveries. Complexity and size of recovery Projects are differentiated by analyst level.

Work Arrangement:
  • Hybrid- Associate must be in the office at least three (3) days per week, including core days of Tuesdays and Wednesdays
Responsibilities:
  • Manage overpayment recovery Project files from various submitters and multiple lines of business
  • Ensure adherence to established Program Integrity (PI) Project file management processes, including overall quality control through the recovery Project's lifecycle
  • Provide regular Project-related feedback to PI Management and submitters through delivery of written status updates as well as during scheduled and/or ad-hoc meetings
  • Utilize strong functional expertise in multiple business areas - including Program Integrity, Claims, and Health Plan Operations - to effectively analyze Project-related data and identify overpayment trends
  • Make recommendations for process improvements that can eliminate or diminish repeated overpayment issues
  • Produce and distribute accurate and timely recovery Project-related reports
  • Work independently as well as with Peers, Manager, and Associates at all levels involving problems/issues that could have a significant financial or organizational impact
Education/ Experience:
  • Minimum of 1 year's experience in a managed care environment with specific experience in medical claims terminology, claims payment, recovery, and/or claims data research and analysis
  • Minimum of 3 years of analytical experience, preferably with Medical Claims data
  • Bachelor's Degree or equivalent Medicaid and/or AmeriHealth Caritas experience
  • Health Care experience required; Medicaid and Medicare experience preferred
  • Successful experience working in a team setting, as well as on large and small project teams required
Skills:
  • Proficiency with MS Access and/or experience importing data into databases, creating queries and reports required. Business Intelligence tools and SQL experience are a plus
  • Working knowledge of Microsoft Office applications to include Excel, Access, Word, and PowerPoint. SharePoint experience is a plus

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.

Your career starts now. We're looking for the next generation of health care leaders.

At AmeriHealth Caritas, we're passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.

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