Note: The job is a remote job and is open to candidates in USA. Healthcare Management Administrators (HMA) is a leading third-party health plan administrator in the PNW, dedicated to providing customized health plans for medium to large-size employers. The Payment Integrity Analyst I role focuses on managing payment integrity programs, conducting detailed data evaluations, and collaborating with internal teams to enhance service delivery.
Responsibilities
- Provide strong analytical, problem-solving and quality assurance skills to support efficient, accurate and timely execution of assigned payment integrity programs
- Combine healthcare knowledge and technical skills using programs including QicLink and Excel and reporting from vendor systems to gather, assess, and perform detailed evaluations of data to:
- Identify issues, recommend solutions, and manage situations to resolution
- Identify, evaluate and deliver new program improvements that increase cost containment results for HMA and its clients
- Track, manage, and report on daily program inventory for short-term prioritization and long-term strategic planning
- Evaluate existing business processes and policies and develop sustainable, measurable improvements
- Produce clear written documentation to ensure consistent and accurate service provision, such as Procedural Work Instructions or Job Aids for core practices and business requirements for program changes
- Collaborate effectively with internal teams including Appeals, Claims, Client Success, and Stop Loss to deliver an informed, coordinated experience for clients and members
- Interact and communicate effectively with payment integrity program vendors and government agencies to meet program expectations
- Maintain current in knowledge of claims processing, job-related systems, and associated government regulations, and pursue education and training relevant to Payment Analyst role
Skills
- High School Diploma required
- ICD-10 & CPT experience required
- 3-5+ year of claims processing experience within the insurance industry
- 2+ year data entry experience
- Intermediate Excel skills with the ability to build effective spreadsheets and manipulate data
- Able to manage a complex daily queue and prioritize workload effectively
- Skilled in identifying root causes of issues through detailed investigation and inquiry
- Able to analyze impacts of potential actions or decisions to determine the optimal choice
Benefits
- Seventeen (IC) days paid time off (individual contributors)
- Twelve paid holidays
- Two paid personal and one paid volunteer day
- Company-subsidized medical, dental, vision, and prescription insurance
- Company-paid disability, life, and AD&D insurances
- Voluntary insurances
- HSA and FSA pre-tax programs
- 401(k)-retirement plan with company match
- Annual $500 wellness incentive and a $600 wellness reimbursement
- Remote work and continuing education reimbursements
- Discount program
- Parental leave
- Up to $1,000 annual charitable giving match
- Flexibility to work schedules that support people in all time zones across the US
- Employees have the option to work remotely or enjoy the amenities of our renovated office located just outside Seattle with free parking, gym, and a multitude of refreshments
- Performance management program is designed to elevate career growth opportunities
- Hosting in person events throughout the year including an annual all hands, summer picnic, trivia night, and a holiday party
Company Overview