Note: The job is a remote job and is open to candidates in USA. Quartz Health Solutions is a healthcare organization focused on supporting members and providers while improving healthcare affordability and quality. The Payment Integrity Policy Analyst drives initiatives to improve medical claims accuracy, develops and communicates payment integrity policies, analyzes data and regulations, and collaborates with executives, providers, and cross-functional teams.
Responsibilities
- Investigate and identify market industry trends
- Perform data analytics to analyze the financial performance of our provider sponsors and risk panels
- Research contracts to ensure compliance with recommended payment integrity policies
- Present recommended payment integrity policies to executive team and provider sponsors
- Create and maintain payment integrity policy for external communication
- Lead cross-functional teams to implement payment integrity policies
- Review, analyze, and respond to internal or external audits related to payment integrity policy
- Analyze regulatory compliance and market industry trends regarding payment integrity policy to continue to align with market and be compliant with federal, state, and ERIS regulations
- Review and respond to escalated provider payment integrity policy appeals
Skills
- Bachelor's degree with 2+ years of payment integrity, coding integrity or revenue integrity experience + OR associate degree with 5+ years of payment integrity, coding integrity, or revenue integrity experience + OR high school equivalency with 8+ years of payment integrity, coding integrity, or revenue integrity experience
- Completion of a medical coding program, health information technology, or health information management
- Certification in CPC, COC, RHIT, RHIA, CCA, and/or CCS
- Ability to demonstrate understanding of CMS and commercial payer policy in written and verbal format
- Strong understanding of claim process, ICD-10 coding, DRG validation, etc
- Strong understanding of healthcare revenue cycle and claims reimbursement
- Proficient in data analytic tools
- Comfortable interfacing with providers at the executive level
- Demonstrate ability to manage multiple projects, set priorities, and adhere to committed schedule
- Strong interpersonal skills and adaptive communication style, complex problem solving, drive for results, innovative
- Excellent written and verbal communication skills including ability to synthesize complex information
- Proven track record of delivering concrete results in strategic projects/programs
- Strong analytical ability and distilling data into actionable results
- Hardware and equipment will be provided by the company, but candidates must have access to high-speed, non-satellite Internet to successfully work from home
Benefits
- Opportunity to use multiple skills sets – medical coding, claims reimbursement, data analytics, contract research, regulatory compliance, provider appeals, and process improvement
- Direct influence on organizational strategy and measurable financial results
- Hardware and equipment will be provided by the company
- Opportunity for career advancement
- Work from home
Company Overview