Business Project Lead Analyst – Payment Integrity
Job Description:
• Lead strategic collaboration between recovery vendors, providers, and internal network partners
• Drive monthly provider and vendor discussions to review overpayment inventory
• Partner with Network and Contracting teams to address uncooperative providers
• Monitor vendor performance and accuracy, translating findings into corrective action plans
• Serve as a subject matter expert on claim identification and recovery processes
• Support client-driven and third-party audit initiatives by reviewing, analyzing, and reporting on recovery accuracy
• Evaluate provider contract audit language and recommend enhancements
• Analyze trends, exclusions, and provider behaviors to quantify financial impact
• Develop and deliver clear, actionable reporting for leadership, providers, vendors, and external stakeholders
• Enable vendor success through education on systems, procedures, and evolving recovery requirements
Requirements:
• High School Diploma or G.E.D. required
• 3+ years of experience in payment integrity, provider relations, claims operations, or related healthcare analytics roles
• 2+ years of hands-on experience with healthcare claim systems such as PROCLAIM and FACETS
• Working knowledge of healthcare claim processing and recovery workflows
• Experience partnering across matrixed teams including Network, Legal, Contracting, Sales, and Operations
• Strong analytical and organizational skills
• Demonstrated ability to manage complex issues with appropriate urgency and sound judgment
• Proficiency in Microsoft Word and Excel
Benefits:
• Medical, vision, and dental health insurance
• 401(k)
• Company paid life insurance
• Tuition reimbursement
• Minimum of 18 days of paid time off per year
• Paid holidays
Apply Now
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• Lead strategic collaboration between recovery vendors, providers, and internal network partners
• Drive monthly provider and vendor discussions to review overpayment inventory
• Partner with Network and Contracting teams to address uncooperative providers
• Monitor vendor performance and accuracy, translating findings into corrective action plans
• Serve as a subject matter expert on claim identification and recovery processes
• Support client-driven and third-party audit initiatives by reviewing, analyzing, and reporting on recovery accuracy
• Evaluate provider contract audit language and recommend enhancements
• Analyze trends, exclusions, and provider behaviors to quantify financial impact
• Develop and deliver clear, actionable reporting for leadership, providers, vendors, and external stakeholders
• Enable vendor success through education on systems, procedures, and evolving recovery requirements
Requirements:
• High School Diploma or G.E.D. required
• 3+ years of experience in payment integrity, provider relations, claims operations, or related healthcare analytics roles
• 2+ years of hands-on experience with healthcare claim systems such as PROCLAIM and FACETS
• Working knowledge of healthcare claim processing and recovery workflows
• Experience partnering across matrixed teams including Network, Legal, Contracting, Sales, and Operations
• Strong analytical and organizational skills
• Demonstrated ability to manage complex issues with appropriate urgency and sound judgment
• Proficiency in Microsoft Word and Excel
Benefits:
• Medical, vision, and dental health insurance
• 401(k)
• Company paid life insurance
• Tuition reimbursement
• Minimum of 18 days of paid time off per year
• Paid holidays
Apply Now
Apply Now