Molina Healthcare is a Fortune 500 managed care company with a storied history that dates back to 1980 and the opening of a medical clinic by Dr. C. David Molina. As an employer, M
Lead Analyst, Payment Integrity
Location
United States
Posted
4 days ago
Salary
$63.1K - $129.6K / year
Seniority
Lead
No structured requirement data.
Job Description
Lead Analyst, Payment Integrity
Molina Healthcare
Role Description Provides lead level analyst support for health plan payment integrity activities. Partners with leaders and functional representatives to drive health plan financial performance through evaluation and execution of operational initiatives tied to payment integrity (PI) and provider claims accuracy. Makes recommendations that inform decisions which contribute to health plan strategy, and acts as a trusted voice in assessing and assisting resolution of complex business challenges that impact cost-containment and regulatory compliance. Qualifications - At least 4 years of business analyst experience in a managed care organization (MCO), and at least 2 years of experience in Medicaid 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 integrity. - Strong working knowledge of managed care claims coding (Current Procedural Terminology (CPT), International Classification of Diseases (ICD), Healthcare Common Procedure Coding System (HCPCS), Revenue Codes), and federal/state Medicaid payment rules. - Strong data analysis/queries experience, and ability to analyze data to inform business decisions. - 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 complex information. - Microsoft Office suite (including advanced Excel), and applicable software program(s) proficiency. - Claims processing background. - Experience with Medicare, Medicaid, and/or Marketplace lines of business. - Payment integrity (PI) programs. Requirements - Assists with and executes projects and tasks to ensure Centers for Medicare and Medicaid Services (CMS) and state regulatory requirements are met for pre-pay edits, post-payment datamining, and overpayment recovery. - Manages scorable action items (SAIs) related to pre-pay editing, post-pay audit, and overpayment recovery initiatives. - Leads efforts to improve claim payment accuracy and financial performance without needing extensive oversight. - Collaborates with operational teams, enterprise 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 able to respond to provider inquiries. - Analyzes data to identify and develop new recovery opportunities. - Conducts peer reviews of recovery concepts and offers recommendations for logical improvements. - Responsible for documenting policies and procedures related to concept approvals. - Conducts trainings and prepares training documentation for teams. Benefits - Molina Healthcare offers a competitive benefits and compensation package. - Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
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EPIC Radiant Application Analyst III
UTHealth (University of Texas Health Science Center at Houston)UTHealth Houston is Texas’ resource for healthcare education, innovation, scientific discovery, and excellence in patient care.
Role Description UTHealth Houston is seeking an Epic Analyst to work with the Radiant module, which supports radiology practices. This position will be responsible for the ongoing design, build, testing, validation, and support of any Radiant modules used across the healthcare system. This analyst works with operational stakeholders and IT technical staff to troubleshoot Epic system issues and problems, capture requirements for new initiatives, and support project planning and execution. Works with end users to communicate improvements needed for business processes and contributes directly to the success of the UTHealth mission across technological, clinical, administrative, and financial perspectives. This is a remote role, but we give preference to candidates who live in Texas or are willing to move here. Qualifications - Certification or accreditation in the Epic Radiant module is required. - Bachelor's Degree in Computer Science, Business, or a related discipline required. 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Benefits - 100% paid medical premiums for our full-time employees. - Generous time off (holidays, preventative leave day, both vacation and sick time – all of which equates to around 37-38 days per year). - The longer you stay, the more vacation you’ll accrue! - Longevity Pay (Monthly payments after two years of service). - Build your future with our awesome retirement/pension plan! - Free financial and legal counseling. - Free mental health counseling services. - Gym membership discounts and access to wellness programs. - Other employee discounts including entertainment, car rentals, cell phones, etc. - Resources for child and elder care. - Plus many more! 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• Empower the team to run their own team ceremonies • Act as a subject matter expert on lean and agile principles • Promote transparency by maintaining clear reporting and visible Agile dashboards • Coach the team towards greater self-organization • Drive a culture of continuous improvement • Partner closely with the Product Owner to ensure the product backlog is healthy • Proactively identify and remove impediments • Facilitate productive communication and collaboration between the team and external stakeholders



