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The Payment Integrity Professional 2 uses technology and data mining, detects anomalies in data to identify potential and collect overpayment of claims. Contributes to the investigations of fraud, waste and abuse within financial recovery. The Payment Integrity Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Payment Integrity Professional 2 performs tasks related to inventory management for the pre-paid medical record reviews. Collaborates with other business partners to ensure they have a document library for all processes. Searches for process improvements gaps as well as opportunities for automation. Reviews extracted data, analyzes trends and other data points to and then present to various different leaders and business partners. Contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
Associate's Degree or higher
Strong attention to detail
Can work independently and determine appropriate courses of action
Ability to handle multiple priorities within a fast paced, metric driven operational setting
Proficient in Excel including complex formulas, pivot tables and charts
Strong background in pulling data using SQL and analyzing data
Excellent communication skills both written and verbal
Experience leading people, projects, and/or processes
Experience in Financial Recovery
Experience using the following systems: CAS, MTV, CISpro and CIS
Scheduled Weekly Hours
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