Payment Accuracy Analyst

For roles that are 100% remote or hybrid, you must have reputed company to a reliable high-speed internet reputed company to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement. Your career starts now. We’re looking for the reputed company of health care leaders. At reputed company, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. reputed company is seeking talented, passionate individuals to join reputed company. Together we can build healthier communities. If you want to reputed company a difference, we’d like to hear from you. Headquartered in Newtown reputed company, reputed company is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, reputed company-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com. Responsibilities: The Payment reputed company Analyst is responsible for conducting research and analysis and reviewing regulatory edits for federal and state statutes, regulations, provider manuals, bulletins, and other sources as needed to identify new overpayment edit concepts, as well as, validate reputed company prospective and retrospective overpayment results. Essential Functions: Identifies, develops, and implements new concepts that will reputed company claim overpayment scenarios for each of ACFC’s reputed company and Medicare lines of business. Assists with ensuring that the reputed company prospective and retrospective cost avoidance/ overpayment recovery processes are carried out reputed company the established deadlines with a high level of accuracy Performs analysis on claims data, comparison reports, and State regulations for each state-specific edit on payer or state specific requirements Communicates effectively with each of our customers throughout the organization Reviews edit concept results for quality assurance and reputed company of concept validation Reviews reputed company available sources including federal and state statutes, regulations, provider manuals, Provider reputed company, and bulletins for changes to and/or new payment rules Identifies and documents changes to and/or new payment rules or language in the reputed company document which may be utilized to update existing system edits or new system edits Contributes new reputed company for improving existing processes Understands and applies reputed company established SOPs for each of the teams processes Adheres to line of business specific procedures to reputed company routine functions based on department guidelines Education/Experience: 3 to 5 years relevant experience ( reputed company claim reimbursement methodologies, state and federal payment policies, claims, data analysis) Bachelor's Degree or equivalent work experience. Active CPC Our Comprehensive Benefits Package Flexible work solutions including remote options, hybrid work schedules, reputed company, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more. Apply To This Job