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Payment Intent Analyst III

Company: Medica
Location: Minnetonka
Posted on: June 6, 2021

Job Description:

The Payment Intent Analyst is responsible for the overall contribution of cost reduction by increasing the accuracy and efficiency of recovering claims paid in error and ensuring claims payment accuracy.

Skills & Abilities:

  • Performs data mining activities to identify potential cases for concept creation and post pay investigation
  • Performs sampling methodologies for medical records requests/reviews e.g. statistically valid random sampling, probe and random samples
  • Performs researching using the Internet, data analysis tools, etc. to identify aberrant patterns and billing behaviors
  • Analyzes data using fraud detection software as part of the investigation process
  • Prepares reports for submission of work performed and recommendations for edits, post pay reviews and over-payments
  • Conducts settlement discussions with providers, legal counsel and/or other associated parties
  • Manages a large case load and ensures turnaround times and quality metrics are met
  • Fosters strong working relationships with internal stakeholders, vendors and peers

Qualifications:

  • Bachelor's Degree or equivalent combination of education and work experience
  • 5+ years professional experience related to claims analytics, investigations or payment integrity
  • Vendor management experience preferred; demonstrated ability to work with external partners required
  • Strong knowledge of health care and industry standard practices
  • Knowledge and proficiency in claims adjudication and claims analysis
  • Knowledge of Commercial, IFB, Medicare Advantage and Medicaid lines of business preferred

Skills and Abilities:

  • Analytical skills
  • Strong written and communication skills
  • Ability to manage a large case volume independently with little supervision
  • Proficient in Microsoft applications; intermediate to advanced proficiency in Excel is required (Pivot Tables, V-Look ups, and ability to manipulate large data sets)

Preferred Certification:

  • AFHI or CFE Certification
  • CPC-P

Keywords: Medica, Minnetonka , Payment Intent Analyst III, Other , Minnetonka, Minnesota

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