SCOPE OF ROLE

Bright’s Senior Payment Integrity Analyst is responsible for executing a claim recovery strategy which includes the analysis of claims data for identifying cost containment opportunities both with internal and external partners. Our Payment Integrity Analysts also work to review and analyze recommendations for recovery found in waste and abuse recovery audits and plays an integral role in ensuring claim integrity as this position supports all recovery efforts for the Claims Operations team.

ROLE RESPONSIBILITIES

The Senior Payment Integrity Analyst job description is intended to point out major responsibilities within the role, but it is not limited to these items. Please note % of time below on role responsibilities may shift depending on the project assigned.

The Payment Integrity Analyst is responsible for executing claims investigation and recovery strategies. This includes analyzing claims data to identify cost containment opportunities across many different claims areas to ensure proper claims payments, as well as conducting in-depth simple to complex claims audits.

Key responsibilities include:

• Investigate, recover and resolve various types of claims as well as recovery and resolution with internal payment integrity solutions.
• Collaborate with Bright staff from various departments as well as external clients to ensure prompt and appropriate action is taken regarding cost avoidance/cost containment activities
• Audit contracts to determine accuracy and validity of claims systems compared to agreements. Work with contracting and configuration teams when inconsistencies found.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• Bachelor’s degree preferred; Five (5) years relevant experience in lieu of a degree
• Three (3) or more years in healthcare claim
• Knowledge of revenue, CPT and HCPCS coding
• Recovery and/or claim auditing/analytic experience required
• Understanding of contract language
• Experience with various payment methodologies, i.e. DRG, Per Diem, Case Rate
• Background in review of claims payment preferred
• Ability to work collaboratively will all levels of leadership
• Project Management experience a plus

PROFESSIONAL COMPETENCIES

• Ideal candidates will have a strong understanding of healthcare, medical claim billing standards, recovery practices, as well as vendor management, operational functions and company operations.
• Ability to manage multiple projects simultaneously and candidates will need strong organizational, analytical, and problem-solving skills
• You are very detail oriented.
• You thrive in fast-paced environments and excel at creating structure and bringing operational rigor to teams.
• You have a passion for creating an effective team environment and resolving conflicts.
• You are self-directed and do a great job of prioritizing.
• Like others on our team, you are humble, mature and check your ego at the door.
• You are brave and always challenge the status quo but respectful and have an open mind.
• You are excited to take ownership at early stage of company.

WORK ENVIRONMENT

Work responsibilities can be performed in one of Bright’s offices, but a remote/work from home/virtual experience is also possible with this position. Limited travel may be required.