Payment Integrity Business Analyst Senior

Role Overview

The Payment Integrity Business Analyst Senior is responsible for supporting initiatives that drive accuracy and operational integrity through in-depth data analysis, business process improvement, and documentation management. This role plays a key part in the Payment Integrity Department’s efforts to identify improper payments, minimize unnecessary costs, and ensure compliance with payer and regulatory standards. You will support the creation and maintenance of critical business documentation, including process workflows, audit procedures, requirements documents, and Policies and Procedures (P&Ps)/Standard Operating Procedures (SOPs) and will be instrumental in developing documentation for internal and external stakeholders.

This role closely collaborates with cross functional teams including, but not limited to, Operations, Compliance, IS, Configuration, Sourcing, and Finance to support new business and project implementations and integrations. To support business development efforts, this role contributes to Request for Proposal (RFP), Request for Information (RFI) and audit responses by supplying subject matter expertise and drafting technical and operational content, which will be submitted to Management for review and approval prior to final submission.

Work Arrangement

• This is a 100% remote position but you must live in EST or CST time zones
  
  

Responsibilities

• Documents and maintains detailed business requirements and payment integrity workflows
• Collaborates with team members and stakeholders to identify business needs and business requirements
• Conducts root cause analysis and makes recommendations for improvements. Presents analysis, ideas, and positions in writing in a clear and convincing manner
• Support the development and management of provider communications, training materials, and policy updates
• Supports the design, development and implementation of new /changed business processes and procedures utilizing proven process improvement methodologies
• Monitors regulatory and policy changes to ensure payment integrity strategies remain compliant
• Assists in pre-RFP and RFP work. Represents Payment Integrity at Corporate RFP meetings. Serves as a technical resource for functional areas in responding to RFPs (identifying standard or historical responses) and coordinates responses with other departments, as necessary. Works collaboratively with functional areas to ensure proposed RFP responses align with current enterprise standards and guidelines and provides feedback when appropriate. Reviews the final version of draft responses submitted for accuracy and usability prior to submission to Management for review

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• Collaborates with cross-functional teams to support project execution
• Monitors project activities to ensure the quality and timeliness of processes as well as ensuring adherence to all company goals and initiatives
• Supports new business initiatives/expansions to ensure operational readiness. Prepare for and facilitating team meetings to review, refine and finalize deliverables as applicable
• Develops and maintains reports to track activities including readiness reviews, audits, and RFPs
• Supports SharePoint Site maintenance to support future initiatives and provides data upon request in a useable format. Updates site to include new business standard documents, workflows, and processes
  
  

Education And Experience

• Bachelor’s Degree
• At least two (2)+ years of experience in healthcare payment integrity or healthcare operations
• At least three (3)+ years of experience in a Business Analyst role
• Strong analytical skills, adept in data analysis and data presentation
• Proficient working knowledge of Microsoft Office Suite, including Excel, SharePoint Online, PowerPoint, Teams, Word, and Tableau
• Previous experience working in healthcare preferred
  
  

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Other Skills

• Ability to work independently and collaboratively to manage multiple projects and tasks to completion
• Knowledge of provider reimbursement methodologies, healthcare regulations and audit practices
• Ability to present information in a clear and concise manner, both written and verbal
• Experience with RFP processes and implementation project support is highly desirable
• Attention to detail with the ability to source data and synthesize solutions to connect people, processes, and technology
  
  

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, 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.

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, 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. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-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.