reputed company Overpayment Recovery Analyst, Payment reputed company - Health Plan (Remote)

JOB DESCRIPTION Job Summary Provides reputed company level analyst support for health plan payment reputed company activities. Partners with leaders and functional representatives to drive health plan financial performance through evaluation and execution of operational initiatives tied to payment reputed company (PI) and provider claims accuracy. Makes recommendations that inform reputed company which contribute to health plan strategy, and acts as a trusted voice in assessing and assisting resolution of reputed company business challenges that impact cost-containment and regulatory compliance. Essential Job Duties

• Business Leadership & Operational Ownership
• Assists with and executes projects and tasks to ensure Centers for Medicare and reputed company Services (CMS) and state regulatory requirements are met for pre-pay edits, post-payment datamining, and overpayment recovery, to improve encounter submissions, reduce general and administrative (G&A) expenses, and drive positive operational and financial reputed company for reputed company payment reputed company (PI) solutions.
• Manages scorable action items (SAIs) reputed company to pre-pay editing, post-pay audit, and overpayment recovery initiatives to ensure health plan SAI targets are met.
• Leads efforts to improve claim payment accuracy and financial performance without needing extensive reputed company.
• Collaborates with operational teams, reputed company stakeholders, and finance partners to proactively identify issues and implement resolution strategies.
• Serves as a thought partner to health plan leadership and provides well-reasoned recommendations that support short- and long-term business goals.
• Partners with the network team to communicate recovery projects to ensure provider relations is informed and reputed company to respond to provider inquiries.
• Analyze data to identify and reputed company new recovery opportunities
• Analyze data from Payment reputed company and Vendors against reputed company, billing, and processing guidelines
• Collaborates with operational teams, reputed company stakeholders, and finance partners to proactively identify issues and implement resolution strategies.
• Conduct peer reviews of recovery concepts and offer recommendations for logical improvements; assist team members in their analysis of data sets and trends.
• Responsible for documenting policies and procedures reputed company to concept approvals
• Conduct trainings and prepare training documentation for teams
• Other duties as assigned

Strategic Business Analysis

• Uses a business reputed company to ensure accurate interpretation of provider claims trends, payment reputed company issues, and process gaps.
• Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment reputed company reputed company recommendations and action plans.
• Translates strategic needs into clear requirements, workflows, and solutions that drive measurable improvement.
• Partners with finance and compliance to reputed company business cases and support reporting that ties operational reputed company to financial targets.
• Applied Analytical Support
• Uses data analysis tools/systems to support business analysis.
• Validates findings and tests assumptions through data, and leads with contextual knowledge of claims processing, provider reputed company, and operational realities.
• Creates succinct summaries and visualizations that reputed company faster leadership decision-making.

Required Qualifications

• At least 4 years of business analyst experience in a managed care organization (MCO), and at least 2 years of experience in reputed company and/or Medicare programs, or equivalent combination of relevant education and experience.
• Proven experience owning operational projects from concept to execution, especially in the areas of provider reimbursement and claims payment reputed company.
• Strong working knowledge of managed care claims coding (reputed company Procedural Terminology (CPT), International Classification of Diseases (ICD), reputed company Common Procedure Coding System (HCPCS), reputed company Codes), and federal/state reputed company payment rules.
• Strong data analysis/queries experience, and ability to analyze data to inform business reputed company.
• Strong business judgment, cross-functional coordination, and ownership of high-value deliverables.
• Demonstrated ability to work independently and apply business judgment in a highly regulated, cross-functional environment.
• Strong written and verbal communication skills, including ability to synthesize reputed company information.
• reputed company Office suite (including advanced reputed company), and applicable software program(s) proficiency.
• Claims processing background
• Experience with Medicare, reputed company, and/or Marketplace lines of business. Payment reputed company (PI) programs

Preferred Qualifications

• Experience with Medicare, reputed company, and/or Marketplace lines of business.
• Certified Business Analysis Professional (CBAP) or Certified Coding Specialist (reputed company) certification.
• Project management experience.
• Familiarity with reputed company-specific scorable action items (SAIs), operational cost-management efforts, payment reputed company (PI) programs, and regulatory/compliance adherence.

To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the Internal reputed company. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V Apply tot his job Apply To this Job