Analysis Skills, Business Case, Channel Strategies, Claims Management, Claims Processing, Cost Control, Cross-Functional, Data Analysis, Documentation Standards, Establish Priorities, Finance, Financial Management, Financial Planning, Financial Trend Analysis, Health Insurance, Health Plan, Healthcare Providers, Healthcare Reimbursement, Identify Issues, Insurance Claims, Internal Audit, Interpersonal Skills, Lean Six Sigma, Managed Care, Multitasking, Payment Processing, Performance Metrics, Problem Solving Skills, Process Improvement, Project/Program Management, Quality Assurance, Regulations, Regulatory Compliance, Reimbursement, Secondary School, Strategic Analysis, Team Lead/Manager, Work From Home
Quartz Health Solutions is seeking an experienced health claims/payment integrity professional with a focus on improving processes that impact payment integrity and payment performance. The Lead Payment Integrity Analyst will be responsible for providing lead level support as a highly capable analyst who serves as a key strategic partner in driving health plan financial performance. This position will focus on identifying and executing operational initiatives tied to Payment Integrity and medical claims accuracy. The Lead Payment Integrity Analyst will lead cross-functional work groups to resolve complex business challenges that impact cost containment and regulatory compliance. This position will partner with operational leaders across the organization to project manage business initiatives, analyze, redesign, standardize, and document end-to-end processes while fostering a culture of sustainable change and operational excellence. Come Find Your Spark at Quartz!
Benefits:
- New position within our growing Payment Integrity Department
- Opportunity to support and deliver on business initiatives that will positively impact the organization’s goals and mission
- Starting salary is based upon skills and experience: $77,200 - $96,500 plus robust benefits package
Responsibilities:
- Financial Performance & Payment Integrity Oversight
- Oversees the financial and key performance indicators related to pre-pay integrity services, post-pay integrity services, premium revenue services, and remediation initiatives to ensure financial and key performance targets are met.
- Collaborates with enterprise stakeholders across organization to proactively identify issues and implement resolution strategies.
- Partners with Provider Network Management to communicate recovery projects to be informed and respond to questions from providers.
- Documents controls, business decisions, and payment integrity oversight to disseminate to the executive team members and Internal Audit Committee.
- Strategic Analysis
- Ensures accurate interpretation of medical claims trends, payment integrity issues, and process gaps.
- Shapes action plans by applying understanding of healthcare regulations, managed care claims workflows, and provider reimbursement model.
- Translates strategic needs into clear requirements, workflows, and solutions that drive measurable improvement.
- Partners with finance, quality assurance, and compliance to develop business cases and supports reporting that ties operational outcomes to financial targets.
Qualifications:
Qualifications:
- Bachelor's degree with 6+ years of payment integrity, claims processing, quality or process improvement experience, including performance measurement systems
- OR associate degree with 9+ years of experience of payment integrity, claims processing, quality or process improvement experience, including performance measurement systems
- OR high school equivalency with 12+ years of payment integrity, claims processing, quality or process improvement experience, including performance measurement systems
- Must have experience with:
- Payment integrity programs
- Health insurance claims processing
- Leading cross-functional workgroups
- Project management
- Lean Six Sigma or problem-solving methodologies
- Strong business judgment
- Strong understanding of claims reimbursement
- Proficient in data analytic tools
- Comfortable interfacing with executives across the organization, and holding cross-functional peers accountable
- Demonstrate ability to manage multiple projects, set priorities, and adhere to committed schedule
- Strong interpersonal skills and adaptive communication style, complex problem-solving skills, drive for results, and innovative
- Strong analytical skills and ability to distill data into actionable results
- Proven track record of delivering results in projects
Hardware and equipment will be provided by the company, but candidates must have access to high-speed, non-satellite Internet to successfully work from home.
We offer an excellent benefit and compensation package, opportunity for career advancement and a professional culture built on the foundations of Respect, Responsibility, Resourcefulness and Relationships. To support a safe work environment, all employment offers are contingent upon successful completion of a pre-employment criminal background check.
Quartz values and embraces diversity and is proud to be an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, gender identity or expression, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified person with disability.