Shire Jobs

Healthcare Claims Integrity Analyst - Hybrid
Innova Solutions has an immediate need for a Payment Integrity (PI) Analyst hybrid in NYC:

• Seeking candidates with managed care / healthcare systems experience on the PAYER side
• HealthEdge (HealthRules Payor), Facets, PowerSTEPP, QNXT, Epic Tapestry, Oracle Health Insurance (OHI), Plexis Healthcare Systems, and/or DST Systems (AMISYS Advance) experience is nice to have
• Proficiency in Excel and SQL is required
• A four year college degree is required
• This job is hybrid onsite 2 days per week in NYC 10010
• Job is a direct hire FTE role. Candidates will be required to work W2, NO C2C or 1099 candidate will be considered.

Job Description

• Assist in the development a stellar payment integrity unit capable of proactively identifying and investigating payment issues and working with stakeholders to develop mitigation strategies to prevent future occurrences, with the ability to review impacts holistically.
• Assist in the development of a comprehensive, strategic roadmap to recover, eliminate, and prevent unnecessary medical-expense spending by reviewing upstream and downstream processes.
• Identify overpayment/underpayment opportunities by data mining, investigation, and quality review 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 claim recovery programs.
• Assist in the development and deployment of mitigation strategies to avoid future overpayments, driving incremental value year over year in both medical and administrative cost savings.
• Manage the day-to-day financial recovery vendor relationships, validating that identified overpayments are valid and recouped.
• Assist in the development and implementation of dashboards to monitor performance.
• Complete and analyze trending reports to identify favorable/unfavorable trends.
• Analyze departmental performance trends and assist with identifying new opportunities to streamline processes and improve performance of key metrics.
• Assist in developing and maintaining payment integrity policies and procedures.

Minimum Qualifications

• Bachelor's degree required
• A minimum of 5 years' working experience within claims in the healthcare or insurance industry
• Extensive knowledge of health care provider audit methods and 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.
• Must understand trend information and be familiar with claim coding practices and industry issues in Medicare payment methodologies.
• Advance level experience with Excel, and MS SQL and other data systems are required.

PAY RANGE AND BENEFITS:
Pay Range- $60-80K/year range Benefits: Innova Solutions offers benefits( based on eligibility) that include the following: Medical & pharmacy coverage, Dental/vision insurance, 401(k), Health saving account (HSA) and Flexible spending account (FSA), Life Insurance, Pet Insurance, Short term and Long term Disability, Accident & Critical illness coverage, Pre-paid legal & ID theft protection, Sick time, and other types of paid leaves (as required by law), Employee Assistance Program (EAP).
Website: https://www.innovasolutions.com/ is an Equal Opportunity Employer and prohibits any kind of unlawful discrimination and harassment. Innova Solutions is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment on the basis of race, color, religion or belief, national origin, citizenship, social or ethnic origin, sex, age, physical or mental disability, veteran status, marital status, domestic partner status, sexual orientation, or any other status protected by the statutes, rules, and regulations in the locations where it operates. If you are an individual with a disability and need a reasonable accommodation to assist with your job search or application for employment, please contact us at hr@innovasolutions.com or (770) 493-5588. Please indicate the specifics of the assistance needed. Innova Solutions encourages all interested and qualified candidates to apply for employment opportunities. Innova Solutions (HireGenics/Volt) does not discriminate against applicants based on citizenship status, immigration status, or national origin, in accordance with 8 U.S.C. § 1324b.
The company will consider for employment qualified applicants with arrest and conviction records in a manner that complies with the San Francisco Fair Chance Ordinance, the Los Angeles Fair Chance Initiative for Hiring Ordinance, and other applicable laws.ABOUT INNOVA SOLUTIONS:Founded in 1998 and headquartered in Atlanta, Georgia, Innova Solutions employs approximately 50,000 professionals worldwide and reports an annual revenue approaching $3 Billion. Through our global delivery centers across North America, Asia, and Europe, we deliver strategic technology and business transformation solutions to our clients, enabling them to operate as leaders within their fields.

Minimum Salary: 60000.00 Maximum Salary: 80000.00 Salary Unit: Yearly