Payment Accuracy Analyst Sr

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

Your career starts now. We are looking for the next generation of health care leaders.

At AmeriHealth Caritas, we are passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in healthcare solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together, we can build healthier communities. If you want to make a difference, we would like to connect with you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.

Role Overview:

The Payment Accuracy Analyst Sr will lead and monitor analytical support to all appropriate lines of business to identify provider overpayments prospectively and retrospectively through our internal data mining team.

Work Arrangement:

• Remote within the United States- Eastern/Central time zones preferred

Responsibilities:

• Examine internal and external vendor data to help improve revenue generation
• Lead the data mining team with prospective and retrospective savings across all LOBs
• Works collaboratively with internal and external clients to increase performance and optimize savings
• Analyze claims payment aberrations and provide explanations for projects and recommended changes
• Validate results and report root causes to cross-functional departments and management
• Collaborate efforts with the Payment Integrity Data Analysis team for query optimization and new edit development
• Ensure a high level of quality assurance with recovery and cost avoidance projects
• Assist in training new and existing associates

Education & Experience:

• Bachelor’s Degree or equivalent experience required
• 5+ years of experience in analytics, data mining, and healthcare
• Demonstrated advanced understanding of the most complex business rules across all business lines
• Demonstrated knowledge of both professional and facility claims processing
• Demonstrated statistical analysis and reporting skills
• High level of technical ability related to database query and provider billing
• Diagnosis and procedure code proficiency
• Ability to follow detailed instructions with a high degree of accuracy
• Ability to manipulate files from and to a variety of formats
• Must be able to work independently, lead others, and pursue several projects simultaneously
• Excellent research and investigative skills with the ability to document and present findings
• Qualitative and quantitative problem-solving skills
• Proficiency with Microsoft products, Excel a must
• Knowledge of SQL and Databricks is a plus

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k), Tuition reimbursement, and more.