Payment Integrity Analyst I

4 hours, 26 minutes ago
Full-time
Mid Level
Data Science and Analytics
Healthcare Management Administrators

Healthcare Management Administrators

Healthcare Management Administrators is a specialized third-party administrator that provides high-quality, innovative, and affordable health plans for self-funded employers, emphasizing exceptional service and a collaborative partnership model.

Insurance
251-1K
Founded 1986

Description

  • Manage the day-to-day execution of assigned payment integrity programs, including CMS Demand Case and Subrogation programs.
  • Use claims expertise, analytics, QicLink, Excel, and vendor reports to evaluate data and support decision-making.
  • Investigate case questions, identify issues, and resolve problems to completion.
  • Recommend and help implement program improvements that strengthen cost containment results.
  • Track, manage, and report on program inventory for both immediate prioritization and long-term planning.
  • Evaluate business processes and policies and develop measurable, sustainable improvements.
  • Create written documentation such as Procedural Work Instructions and Job Aids to support consistent program operations.
  • Collaborate with internal teams including Appeals, Claims, Client Success, and Stop Loss to support clients and members.
  • Communicate with program vendors and government agencies to ensure program expectations are met.
  • Maintain current knowledge of claims processing, job-related systems, and relevant government regulations.

Requirements

  • High school diploma required.
  • ICD-10 and CPT experience required.
  • 3-5+ years of claims processing experience within the insurance industry.
  • 2+ years of data entry experience.
  • Intermediate Excel skills, including building spreadsheets and manipulating data.
  • Ability to manage a complex daily queue and prioritize workload effectively.
  • Strong root-cause analysis skills through detailed investigation and inquiry.
  • Ability to assess the impact of possible actions or decisions and choose the optimal option.
  • Experience with healthcare claims, payment integrity, or similar program work is preferred.
  • Willingness to pursue education and training relevant to the Payment Integrity Analyst role.

Benefits

  • Base salary of $73,000-$81,000 in the greater Seattle area, depending on geography, skills, experience, education, and other factors.
  • Performance-based incentive bonus eligibility.
  • 17 paid time-off days for individual contributors.
  • 12 paid holidays, plus 2 paid personal days and 1 paid volunteer day.
  • Company-subsidized medical, dental, vision, and prescription insurance.
  • Company-paid disability, life, and AD&D insurance, plus voluntary insurance options.
  • 401(k) retirement plan with company match.
  • Annual $500 wellness incentive and $600 wellness reimbursement.
  • Remote work option and continuing education reimbursements.
  • Parental leave.
  • Up to $1,000 annual charitable giving match.
  • Flexible work schedules across U.S. time zones.
  • Access to a renovated office near Seattle with free parking, a gym, and refreshments.

Interested in this position?

Apply directly on the company website

Apply Now

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