SUMMARY:

Under the supervision of the Configuration Manager, the Payment Integrity Analyst Senior is responsible for interpreting results using a variety of techniques; ranging from simple data aggregation via statistical analysis to complex data mining independently. Maintenance and building of fee schedules for provider contracts.

REQUIREMENTS:

• Bachelors Degree Preferred
• Strong background in analysis, design, development, testing and support of complex information systems with an emphasis on data integrity and quality control
• Strong Microsoft Office application skills including Microsoft Word and Excel (VLOOKUP, Pivot Tables, Index/Match, Formulas, and creating spreadsheets)
• Strong understanding of healthcare claims data, pricing, and claims editing concepts, including UB04 and HCFA 1500 claim content
• Experience with interpreting complex provider agreements
• Experience in healthcare claims adjudication, system configuration, and auditing
• Minimum of 6 years of experience working with data analytics (preferably in healthcare)
  Work Schedule:

• Lead and perform complex analysis in an evolving data environment
• Lead projects that require data mining, analysis, and presentation
• Identify relevant trends, do follow up analysis and prepare visualizations
• Extract and analyze data, patterns, and related trends, with the subsequent ability to synthesize the data into information consumable by business

decision-makers

• Uses advanced research and statistical methods to conduct comprehensive analyses on the data collected from various operational processes
• Consults with requestors of informational topics related to research and decision-making analyses
• Performs other duties as assigned
• Uploading and exporting new fee schedules from CMS, Tricare (CHAMPUS), or custom into claims system.
• Research and maintaining updates of current fee schedule that are made in CMS and Tricare (CHAMPUS).
• Ability to gather and analyze data, reason logically, draw valid conclusions and make appropriate concise information and recommendation

available in both oral, written and visual formats

• Knowledge of data relationships, how data is input (manually and electronically) into the system, and how the data is reported
• Possess analytical skills related to the development of report specifications, data reporting and data modeling