Operations Associate, Payment Integrity

Job Summary

A company is looking for an Operations Associate, Payment Integrity.

Key Responsibilities

• Facilitate end-to-end processes for vendor solutions to ensure accurate billing and provider reimbursement
• Monitor, analyze, and report on claims inventory to ensure compliance with CMS timelines and policies
• Collaborate with various teams and stakeholders to optimize outcomes and support the recovery process

Required Qualifications

• Bachelor's degree or equivalent professional experience with 2+ years in healthcare
• Proficiency in Excel or Google Sheets
• Knowledge of CMS rules and regulations along with claims processing or auditing experience
• SQL and statistical analysis capabilities, and medical coding certifications (AAPC/AHIMA) are a plus
• Experience with healthcare analytics platforms and value-based care models is advantageous