Business Project Lead Analyst – Payment Integrity
Location
United States
Posted
29 days ago
Salary
$75.7K - $126.1K / year
Seniority
Senior
High School3 yrs expEnglish
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
Job 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
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