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Payment Accuracy Analyst

Amerihealth Caritas Health Plan

This is a Contract position in Mansfield, TX posted August 7, 2021.

Responsibilities: The Payment Integrity Analyst is responsible for conducting research and analysis and reviewing regulatory edits for federal and state statutes, regulations, provider manuals, bulletins, and other sources as needed to identify new overpayment edit concepts, as well as, validate all prospective and retrospective overpayment results.

Essential Functions: Identifies, develops, and implements new concepts that will target claim overpayment scenarios for each of ACFC’s Medicaid and Medicare lines of business.

Assists with ensuring that the current prospective and retrospective cost avoidance/ overpayment recovery processes are carried out within the established deadlines with a high level of accuracy Performs analysis on claims data, comparison reports, and State regulations for each state-specific edit on payer or state specific requirements Communicates effectively with each of our customers throughout the organization Reviews edit concept results for quality assurance and proof of concept validation Reviews all available sources including federal and state statutes, regulations, provider manuals, Provider contracts, and bulletins for changes to and/or new payment rules Identifies and documents changes to and/or new payment rules or language in the source document which may be utilized to update existing system edits or new system edits Contributes new ideas for improving existing processes Understands and applies all established SOPs for each of the teams processes Adheres to line of business specific procedures to perform routine functions based on department guidelines Education/Experience: 3-5 years relevant experience ( healthcare claim reimbursement methodologies, state and federal payment policies, claims, data analysis) Bachelor’s Degree or equivalent work experience 06022021

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