Clinical Claims Analyst / Quantitative or Qualitative / Hybrid Role
RCM Health Care Services
New York, NY
Clinical Claims Analyst / Quantitative or Qualitative / Hybrid Role
RCM Health Care Services
New York, NY
Expired: 18 days ago
Applications are no longer accepted.
- $80,000 to $86,000 Yearly
- Vision , Medical , Dental , Life Insurance , Retirement
- Full-Time
Job Description
Company Info
Job Description
Payment Integrity Analyst / Managed Care Claims / Hybrid Position (2-3 days in Manhattan office, 2-3 days remote)
For over three decades, this health plan has been dedicated to fostering strong connections with members and providers, empowering New Yorkers to lead their healthiest lives. They deliver top-notch healthcare services to residents across Bronx, Brooklyn, Manhattan, Queens, and Staten Island through a comprehensive range of products.
Payment Integrity Analyst - Hybrid Position (2-3 days in Manhattan office, 2-3 days remote)
Overview:
#ZR
Company DescriptionFor over three decades, this health plan has been dedicated to fostering strong connections with members and providers, empowering New Yorkers to lead their healthiest lives. They deliver top-notch healthcare services to residents across Bronx, Brooklyn, Manhattan, Queens, and Staten Island through a comprehensive range of products.
Payment Integrity Analyst - Hybrid Position (2-3 days in Manhattan office, 2-3 days remote)
Overview:
- Contribute to the formulation of a strategic roadmap aimed at recovering, eliminating, and preventing unnecessary medical expense spending.
- Support the execution of a robust claim accuracy program, optimizing pre/post claim editing, auditing, and recovery initiatives for sustained value growth.
- Utilize analytics, trends, and competitor benchmarking to identify savings opportunities, develop mitigation strategies, and achieve business goals.
- Contribute to building an exceptional payment integrity unit capable of proactively identifying and investigating payment issues, collaborating with stakeholders to develop prevention strategies.
- Assist in creating a comprehensive roadmap to curtail unnecessary medical expense spending by reviewing upstream and downstream processes.
- Identify overpayment/underpayment opportunities through data mining, investigation, and quality reviews on benefit and/or provider configuration, rate loads, rate assignments, COB, claims payment logic, etc.
- Support the execution and maintenance of a corporate claim accuracy program by optimizing pre/post claim editing, auditing, and recovery programs.
- Contribute to the development and deployment of mitigation strategies to prevent future overpayments, driving incremental value in both medical and administrative cost savings.
- Manage day-to-day financial recovery vendor relationships, ensuring validation and recoupment of identified overpayments.
- Contribute to the development and implementation of dashboards for performance monitoring.
- Complete and analyze trending reports to identify favorable/unfavorable trends.
- Analyze departmental performance trends, identifying opportunities to streamline processes and enhance key metric performance.
- Assist in developing and maintaining payment integrity policies and procedures.
- Bachelor’s degree required.
- Minimum of 5 years' experience in claims within the healthcare or insurance industry.
- Extensive knowledge of healthcare provider audit methods, provider payment methods, clinical aspects of patient care, medical terminology, and medical record/billing documentation.
- Proven ability to apply quantitative and/or qualitative research and data analysis techniques to improve operational processes.
- Familiarity with claim coding practices and industry issues in Medicare payment methodologies.
- Advanced proficiency in Excel required. SQL and other data systems strongly preferred.
#ZR
RCM Health Care Services’ mission is to provide opportunities for qualified candidates across medical professions. We deliver timely results and have built a reputation of trust with our clients and candidates. Since 1975, we have been providing staffing solutions to many of the finest healthcare institutions across the nation and careers for thousands of candidates. As professional career opportunity matchmakers, we follow up and follow through to help our clients and candidates to reach their career and life goals. We proudly hold the Joint Commission Gold Seal of Approval as well.
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