Payment Integrity Analyst II

Job Summary

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

Key Responsibilities

• Investigate and validate payment errors, ensuring compliance with payment policies and contract terms
• Collaborate with the team to analyze claims and maintain documentation for audits and inquiries
• Identify process improvements and contribute to operational excellence within the Data Mining program

Required Qualifications

• Minimum of five (5) years of experience in healthcare, including claims processing or payment integrity
• Minimum of three (3) years auditing medical claims or performing payment integrity casework
• Minimum of three (3) years performing data analysis with large datasets
• Working knowledge of medical billing codes and understanding of reimbursement methodologies
• Bachelor's degree in business or healthcare-related field preferred