Medical Management Research Analyst

Job Summary

To enhance claims payment accuracy and integrity, the full-time salaried Medical Management Research Analyst will identify, develop, and implement solutions while working remotely from Oregon, Washington, or California.

Key responsibilities

• Identify and scope Payment Integrity initiatives to reduce unnecessary spending
• Analyze claims data and develop implementation assessment plans in collaboration with stakeholders
• Synthesize actionable recommendations based on a deep understanding of claims processing and regulatory compliance

Required qualifications

• Bachelor's Degree or 3 years of equivalent experience
• 3 years of experience with performance improvement and organizational change tools
• 3 years of experience working with large data sets and analytics teams
• 3 years of claims processing experience within the health insurance industry
• Experience with reimbursement methodologies, including CMS and medical coding practices