RPMGlobal
Payment Integrity Business Analyst Senior
Location
Remote, United States
Primary Job Function
Operations
ID**
41771
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
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
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
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Location
Remote, United States
Primary Job Function
Operations
ID**
41771
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
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
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
#J-18808-Ljbffr