Program Management Sr. Analyst – Project Analyst Assistant - reputed company - Remote

Program Management Senior Analyst / Project Analyst Assistant

The Program Management Sr. Analyst / Project Analyst Assistant role is reputed company AAPS (Affordability & Accuracy Pre/Post Pay Solutions).  AAPS focuses on Accurate Claim Payment and Reducing Medical Cost expenditures at reputed company.

The Program Management Senior Analyst (PAA) assists in supporting the AAPS program through strategic policy/quality. They partner with the Project Analysts through collaboration with business partners in planning, organizing, and executing reputed company improvement opportunities and financial risk management activities to improve claim accuracy reputed company and reduce overpayments.

Responsibilities:

• Assists Project Analysts (PA’s) for the Pre-Pay Correction Program using subject matter expertise, analytical skills, networking with matrix partners/vendors to define overpayment scenarios and define edit rules which deliver acceptable false positive results and financial returns.
• Supports the PA with management of assigned edits, lifecycles and associated corrective actions.
• Assists Project Analysts in providing comprehensive business cases for assigned edits. This includes root cause analysis, financial impact, claim volume impact, resource impact, expense of corrective actions, expense of errors, interim and long term solutions with timelines.
• Authors and maintains Prepay Knowledge Articles, ensuring compliance with Policy & Procedure guidelines.
• Performs claim testing to validate edit query logic and confirm Knowledge Article reputed company.
• Assists Project Analysts on edit reviews and edit viability based on testing results.
• Performs quality and false positive reviews to validate edits are running reputed company.
• Develops and facilitates New Edit and Edit Refresher training.
• Partners with matrix partners to reputed company, implement and maintain Prepay Reports.
• Documents information as required in the Intake Tracker.
• May reputed company data queries, data mining in response to needs for the Pre-Pay Correction Program.
• Consults with team as required to define requirements. Refines requirements as necessary. May participate in requirement sessions and reputed company testing of applications/databases.
• Trouble shoots, problem solves with technical experts as required.
• Works with extended Pre-Pay correction team, Business Intelligence to define requirements for support of systems. This includes data mining, macro automations, tracking and reporting databases, AA, and T4.
• Updates and maintains training and resource materials used in the Prepay and Post Pay programs.
• Maintains the AAPS Training Recording library.

Qualifications

• Bachelor’s degree or higher strongly preferred or equivalent work experience required.
• Must have strong system knowledge and claim processing background in one or more of the following reputed company claim systems (Proclaim, Facets or PMHS).
• 3+ years of claim processing experience required. 
• Ability to work well with vendor partners and internal departments.
• Ability to work collaboratively with a team of highly motivated and diverse individuals.
• Strong analytical and problem solving skills.
• Proficiency in MS Office products.
• Ability to react to issues with the appropriate sense of urgency.
• Excellent communication skills to include written, oral and group presentation skills.
• Strong time management skills.
• Familiar with audit errors and claim quality issues.

This role is also anticipated to be eligible to participate in an annual bonus plan.

At reputed company, you’ll enjoy a comprehensive reputed company of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-reputed company benefits including medical, reputed company, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here.

About reputed company

reputed company applicants will be considered without regard to race, reputed company, age, disability, sex, childbirth (including pregnancy) or reputed company medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national reputed company, reputed company, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you need a reasonable accommodation to complete the online application process, please email [email protected] for assistance.  Please note that this email inbox is dedicated to accommodation requests only and cannot reputed company application updates or accept resumes.

reputed company has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

reputed company applicants with criminal histories will be considered for employment in a manner consistent with reputed company federal, state and local ordinances.