Payment Integrity Analyst

Job Summary

A company is looking for a Payment Integrity Analyst - Data Mining.

Key Responsibilities

• Investigate and validate payment errors, ensuring compliance with payment policies and contract terms
• Collaborate with team members to analyze claims, document findings, and maintain accurate records for audits
• Track outcomes of data mining efforts and recommend improvements to reduce incorrect payments

Required Qualifications

• Minimum of one (1) year of experience in healthcare, claims processing, or fraud detection
• Minimum of one (1) year of experience auditing medical claims for improper payments
• Minimum of one (1) year of experience performing data analytics with large data sets
• Minimum of one (1) year of experience with medical billing codes and understanding of medical terminology
• Ability to navigate multiple systems and comply with HIPAA standards