Senior Payment Integrity Analyst at Bright Health
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Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes.
What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative.
If you share our passion for changing healthcare so all people can live healthy, brighter lives – apply to join our team.
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.
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
- 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 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.
We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.