Payment Integrity & Reimbursement Analyst - Full-time

at  Avera Health Plans

Join the team at Avera!
Award Winning Health Care: Avera has been named among the nation’s 15 Top Health Systems, Forbes list of America’s Best-in-State Employers and Level 10 Most Wired Health Care Organization by CHIME.
Culture: Be part of a multidisciplinary team built on teamwork, with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.
You Belong at Avera: Competitive pay, front-loaded PTO and options for free health insurance, sign-on bonuses, various shifts to fit your lifestyle and opportunities for career growth.
Join Avera as a Payment Integrity & Reimbursement Analyst and join a mission driven organization with a great company culture, and team environment.

Position Highlights:

• Paid Time Off (PTO) available on Day 1!
• Options for Free Health Insurance!
• Positive Work Environment: Be part of an organization where we practice the mission in our daily operations.
• Career Growth opportunities!

JOB SUMMARY

The Payment Integrity and Reimbursement Analyst oversees and manages the enhancement of claim outcomes across existing and emerging product lines within the Network Services organization. Responsibilities include orchestrating collaborative efforts with cross-functional teams to devise and implement project strategies, mitigate risks, monitor progress, lead process optimization endeavors and create transformative change. The Payment Integrity and Reimbursement Analyst will assist in the development of a strategic roadmap to recover, eliminate, and prevent unnecessary medical-expense spending and support the execution for a comprehensive claim accuracy program. Expert level comprehension of claims platform, provider data, and reimbursement data with a deep understanding on the impact to the end-to-end claims process, and exceptional communication are imperative for success. Acts as subject matter expert (SME), serves as a resource and mentor for other staff. Maintaining network KPI reports and performance dashboards. In addition, this role will assist provider training, orientation, and coaching for performance improvement within the network. The Payment Integrity and Reimbursement Analyst will employ use of analytics, trends, competitor benchmarking, and outcomes to continually identify savings opportunities, develop mitigation strategies to avoid future overpayments/underpayments, and implement plans to achieve business goals.

EDUCATION AND/OR EXPERIENCE

• Bachelor’s degree required. Master’s degree preferred
• Minimum of five (5) years of progressive experience in the health care industry.
• Minimum of three (3) years of applicable experience in Payment Integrity and Reimbursement.
• Minimum of five (5) years of applicable experience with health insurance preferred.

Please refer the Job description for details