Payment Accuracy Recovery Analyst Associate

Overview

The Payment Accuracy Recovery Analyst is responsible for identifying, validating, and recovering improper payments across medical claims and provider reimbursements. This role owns enterprise-wide payment integrity initiatives by analyzing claims data, collaborating with internal and external stakeholders, and executing recovery strategies that improve financial performance and reduce waste. Owns payment recovery communication with providers and engages with providers offices via face-to-face and virtual meetings. Supports managing payment accuracy vendor partner relationships.

We're determined to take care of those working in healthcare.

Presbyterian is dedicated to improving people's lives - the lives of our patients and the lives of our coworkers. We're a locally owned and operated, which encourages supportive leadership that empowers employees. And we provide the opportunity to grow from entry-level to the most senior positions.

Why Join Us

• Full Time - Exempt: Yes
• Job is based at Rev Hugh Cooper Admin Center
• Work hours: Days
• Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees

Ideal Candidate:

• Associate degree
• 6 months of Health Rules Payer specific experience.
• 6 months of Payment Integrity Vendor specific experience

Qualifications

• Associate degree in related technical/business; 3 years of additional experience can be substituted in lieu of degree.
• 6 months of Health Rules Payer specific experience.
• 6 months of Payment Integrity Vendor specific experience
• Microsoft Office skills
• Knowledge of medical claims processing, coding - ICD, CPT, HCPCS, and reimbursement methodologies.

Responsibilities

Responsibilities:*Independent ownership and responsibility for payment accuracy financial recovery work to ensure accurate provider claims payment and support lowering the total cost of care for all lines of business - Medicaid, Medicare, Commercial and ASO. *Manage post-payment reviews and audits to identify overpayments, duplicate claims, and billing anomalies securing financial recourse for the health plan.*Manage multiple cross functional teams and vendors -SIU, external vendors and internal PHP teams to validate findings and initiate recovery actions with each independent agency.*Leads audit and reviews on adjudication and coding errors to ensure on time and accurate payment.*Own end to end executive level business process and data analysis across all provider reimbursement methods, influencing our partners by telling the right story with data. *Own maintaining accurate claims payment to support the success of the ongoing payment accuracy identification and recovery for the health plan. *Build, maintain, track and report recovery performance, ROI, and trends using dashboards and analytics tools.*Accountable for strategic decision making to ensure accuracy, timeliness and clear communication of the payment accuracy recovery operation for the health plan. *Lead prospective payment integrity efforts by identifying patterns and recommending edits or policy changes to prevent future errors and overpayments, reading out on trends to executive PHP leadership and developing mitigation strategies.*Collaborate with finance, compliance, and provider relations to ensure accurate and timely resolution of recovery cases.*Establish process for documentation and governance in accordance with regulatory and contractual requirements for payment accuracy of the health plan.*Responsible for holding providers accountable through facilitating compliance with provider contracts.*Point of contact for identifying and resolving outlier billing errors.*Responsible for communication between PHP payment accuracy team and provider and partner business offices.*Other duties as assigned.

Benefits

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian? As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services Presbyterian exists to ensure the patients, members and communities we serve can achieve their best health. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

Maximum Offer for this position is up to

USD $37.58/Hr.

Compensation Disclaimer

The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.