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Analyst, QA and Operations, Payment Integrity

Company: Evolent Health
Location: Saint Paul
Posted on: January 15, 2022

Job Description:

**It's Time For A Change...**

**Your Future Evolves Here**

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely - about 40% in year-over-year revenue growth in 2018. Are we recognized? Definitely. We have been named one of "Becker's 150 Great Places to Work in Healthcare" in 2016, 2017, 2018 and 2019, and one of the "50 Great Places to Work" in 2017 by Washingtonian. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you're looking for a place where your work can be personally and professionally rewarding, don't just join a company with a mission. Join a mission with a company behind it.

**What You'll Be Doing:**

The Payment Integrity Quality Assurance Analyst is responsible for performing Payment Integrity activities to include validation of findings: and the identification, development, completion of a pipeline of new Payment Integrity initiatives to drive incremental savings for the organization. This position would additionally provide support in tracking pipeline project status and Payment Integrity cost avoidance development.

+ Analyze and validate findings for approved scenarios, from both internal and external sources, to the standards of QA and timeliness within the department.

+ Analyze findings to create and execute strategies that determine the global impact of the opportunity and recover overpayments of each opportunity.

+ Tracks all recoveries by opportunity.

+ Performs all follow up functions including overseeing remediation reporting and end project QA analysis as needed.

+ Analyze incoming internal and external correspondence to determine additional needs; review, research and resolve inquiries; and, track all submissions to ensure all inquiries are resolved and department metrics are met.

+ Analyze correspondence to identify strategies that determine future pipeline opportunities. Support team efforts in leading concepts/projects to completion/implementation and perform necessary research of governmental regulatory agencies for reference as needed.

+ Support the Sr QA and analysts in developing and implementing prospective internal controls preventing future overpayments of each pipeline opportunity.

+ Perform other duties as assigned.

**The Experience You'll Need (Required):**

+ With High School Diploma/GED: 5 years of healthcare (Medicare, Medicaid, Commercial) Payment Integrity or program integrity experience.

+ Experienced in interpreting complex contractual terms with Providers, Facilities, Plan Partners, delegated groups.

+ Experienced in working with Hospital and Provider Billing Departments.

+ In-depth knowledge of medical billing and coding

+ Knowledge of payment integrity services including data mining, clinical auditing, subrogation, credit balance, worker's compensation or fraud, waste and abuse

+ In-depth knowledge of Medical Claims processing

+ Knowledge of ACH and other payment transaction processing.

+ Knowledge of health insurance, HMO and managed care principles

+ Critical thinking skills to build efficiencies

+ To be able to focus on multiple projects

+ Excellent interpersonal, oral and written communication skills

+ Strong attention to detail and organization

+ Able to work independently; strong analytic skills

+ Strong computer skills

+ Highly proficient in MS Excel and MS word. Proficiency in MS Access is desired but not required.

+ Ability to find and willingness to suggest solutions with little or no guidance

+ Strong financial reporting skills

+ Detail oriented and organized

+ Able to work independently and prioritize workload.

**Finishing Touches (Preferred):**

+ With Associate Degree: 4 years of healthcare (Medicare, Medicaid, Commercial) Payment Integrity or program integrity experience.

+ With Bachelor's Degree: 2-3 years of healthcare (Medicare, Medicaid, Commercial) Payment Integrity or program integrity experience.

**Technical requirements:**

Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 MBPS and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

Evolent Health is committed to the safety and wellbeing of all its employees, partners and patients and complies with all applicable local, state, and federal law regarding COVID health and vaccination requirements. Evolent expects all employees to also comply. We currently require all employees who may voluntarily return to our Evolent offices to be vaccinated and invite all employees regardless of vaccination status to remain working from home. Certain jobs require face-to-face interaction with our providers and patients in client facilities or homes. Employees working in such roles will be required to meet our vaccine requirements without exception or exemption.

**Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.**

Compensation Range:

The typical range of employees within the compensation grade of this position is . Salaries are determined by the skill set required for the position and commensurate with experience and may vary above and below the stated amounts.

Keywords: Evolent Health, St. Paul , Analyst, QA and Operations, Payment Integrity, Professions , Saint Paul, Minnesota

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