Michigan Licensed Senior Operations Analyst

Job Summary

Serving as a subject matter expert in Provider Network Operations, the fully remote Michigan Licensed Senior Operations Analyst will manage operational accuracy, regulatory compliance, and claims configuration while conducting audits and overseeing provider data.

Key responsibilities

• Review and approve Payment Integrity vendor edits and manage encounter error reconciliation
• Conduct User Acceptance Testing (UAT) and audit provider data and claims configurations
• Analyze state policy changes and manage internal or vendor medical policy edits and initiatives

Required qualifications

• American Academy of Professional Coders (AAPC) certification (CPC, COC, CIC, CRC) or NHA (CBCS) certification required
• Associate's degree preferred or equivalent education and experience in a healthcare field
• 3 to 5 years of claims analysis experience in healthcare, managed care, or Medicaid environment preferred
• Knowledge of claims processing and provider data maintenance required
• Strong working knowledge of Microsoft Excel, Access, Word, and data analytics tools