HealthEdge Software Inc - Senior Payment Integrity Analyst - Indianapolis, Indiana
We are seeking a Senior Payment Integrity Specialist to play a key role in building and implementing proprietary healthcare edits that drive cost savings and accuracy in claims processing. The successful candidate will be responsible for taking a senior level role in analyzing claims data, as well as translating contract terms, policies, and regulatory guidelines into actionable requirements for our proprietary edit library. This role involves close collaboration with subject matter experts, technical teams, and internal/external partners to ensure the effectiveness and relevance of our edits.
The Product:
With Source, we’re changing the industry narrative, providing a more holistic approach to payment integrity that focuses on comprehensive reimbursement, agile editing, and integrated analytics. Our interoperable, cloud-based solution is modular to meet a health plan’s needs today and extensible to grow with their organization over time—bringing disparate parts of a payer’s organization together for improved accuracy and insights.
Your Impact:
- Develop requirements for proprietary healthcare edits, conducting comprehensive reviews of contracts, policies, and state/federal guidelines.
- Drive collaboration with subject matter experts and technical teams to translate these requirements into functional specifications for our proprietary healthcare edits.
- Own the communication of proposed proprietary healthcare edits to internal and external stakeholders, ensuring clarity and addressing any questions or concerns.
- Be responsible for creating and maintaining detailed documentation to support the building and implementation of proprietary healthcare edits, including specifications, test plans, and user guides.
- Provide continuous monitoring and evaluation of the performance of proprietary healthcare edits, proactively identifying opportunities for optimization and enhancement based on industry trends and regulatory changes.
What You Bring:
- Bachelor’s degree in Healthcare Administration, Business, Finance, Computer Science, or a related field.
- Minimum of 3 years of experience in healthcare payment integrity, content & policy, contracts, claims processing, or a closely related field.
- Proven track record of developing and implementing proprietary healthcare edits.
- Excellent communication and interpersonal skills.
- Strong analytical and problem-solving abilities.
- Experience with documentation management tools and methodologies, such as Confluence or SharePoint.
HealthEdge commits to building an environment and culture that supports the diverse representation of our teams. We aspire to have an inclusive workplace.
Geographic Responsibility: While HealthEdge is located in Burlington, MA you may live anywhere in the US
Type of Employment: Full-time, permanent
Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:
- The employee is occasionally required to move around the office.
- Long periods of time sitting and/or standing in front of a computer using video technology.
- May require travel dependent on company needs.
The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required.
Job Locations: US-Remote
ID: 2024-4725
Position Type: Full-Time
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