Payment Cycle Analyst II
Core
Analyze claims data and clinical editing systems to identify reimbursement errors, validate payment policies, and support configuration of clinical editing tools for a health plan.
Role type
Senior IC payment cycle analyst (health claims)
Builds
Claims payment accuracy and clinical editing configurations
Domain
Healthcare / Managed Care
Deliverable
production ML models | dashboards & analysis | client delivery
Required skills
Claims operations analysis, Clinical editing system configuration, CPT/HCPCS/ICD-10 coding knowledge, Data analysis and trending, Regulatory compliance (HIPAA/CMS), System change policy support, Provider education materials creation, Root cause analysis of payment discrepancies
Preferred skills
Facets software proficiency, Certified Medical Coder certification, Medicaid/Medicare program knowledge
Technologies
Microsoft Suite (Word, Excel, Access, Visio), Facets, Reporting packages
Responsibilities
Define clinical and payment policy requirements for system configuration, Research and analyze claim results to identify errors and root causes, Conduct UAT and post-production validation of implementations, Create communication materials summarizing findings for providers and stakeholders, Monitor configuration and SOPs to ensure payment accuracy, Assist in developing policies for claims processing and appeals
Seniority
Mid-Senior, hands-on IC
