• Job Description

  Req#: POSTP004320
  Medica's Post Payment - Payment Integrity Analyst III is responsible for triaging, investigating and resolving instances of healthcare error, waste and/or abusive conduct by medical professionals after payment is issued. Using information from tips and complaints from plan members, the medical community and internal software, our Analysts conduct reviews and investigations and document relevant findings, working with Medica's Special Investigations Unit (SIU) as appropriate.
  
  In addition, the Post Payment - Payment Integrity Analyst III will conduct provider claim and/or clinical reviews to gather and analyze all necessary information and documents related to the investigation/review.
  
  This position is a Remote role. The employee must be located in any state in which Medica is an employer and will work remotely 100% of the time.
  
  Required Qualifications
  
  
  • HS Diploma or equivalent; equivalent combination of education and work experience will also be considered
  • 3+ years of Payment Integrity or SIU related work experience
  • Intermediate Excel experience (basic data analysis using functionality within Excel such as pivot tables, writing basic formulas, etc.)
  
  
  Preferred Qualifications
  
  
  • Direct experience working in Fraud/Waste/Abuse, SIU, Payment Intent and/or Payment Integrity
  • Demonstrated experience in analyzing healthcare claims data and conducting root cause analysis
  • Knowledge of claims processing and provider billing
  
  
  Skills and Abilities
  
  
  • Strong analytic and problem-solving ability
  • Strong attention to detail including analytical and decision-making skills
  • Ability to work independently as well as collaboratively as part of a team
  • Demonstrated written and verbal communication skills
  
  
  Medica's commitment to diversity, equity and inclusion (DEI) includes unifying our workforce through learning and development, recruitment and retention. We consistently communicate the importance of DEI, celebrate achievements, and seek out community partnerships and diverse suppliers that are representative of everyone in our community. We are developing sustainable programs and investing time, talent and resources to ensure that we are living our values. We are an Equal Opportunity/Affirmative Action employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.
  
  Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
  
  The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)

• About the company

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