L.A. Care Health Plan
Payment Integrity Analyst III (ALD)
L.A. Care Health Plan, Los Angeles, California, United States, 90079
Payment Integrity Analyst III (ALD)
Job Category: ClaimsDepartment: Claims IntegrityLocation: Los Angeles, CA, US, 90017Position Type: Full TimeRequisition ID: 11205Salary Range:
$77,265.00 (Min.) - $100,445.00 (Mid.) - $123,625.00 (Max.)Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan, serving more than 2 million members in five health plans.Mission:
L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities.The Payment Integrity Analyst III is responsible for leading or assisting in vendor implementations and configuration, algorithm/edit customizations, overpayment remediation, and other Payment Integrity functions. This position also supports Payment Integrity solutions focused on trending overpayment and refund reasons to identify and develop a pipeline of new initiatives.Duties
Serves as vendor oversight monitoring to ensure proper submission of files and correct invoicing, as well as monitoring QA metrics to meet all vendor estimates.Serves as SME for all Payment Integrity functions, including both Retrospective Data Mining and Pre-Payment cost avoidance.Supports the creation and execution of strategies that determine the impact of opportunities and recover overpayments.Fields and responds to escalated requests for all inquiries, including Provider Dispute Resolution requests.Identifies and defines Payment Integrity issues, reviews and analyzes evidence, and utilizes data for verification.Serves as a subject matter expert and assists in algorithm/edit customizations and vendor implementations.Performs other duties as assigned.Education Required
Bachelor's Degree. In lieu of degree, equivalent education and/or experience may be considered.Experience
Required:At least 3-5 years of experience in Cost Avoidance and/or Coordination of Benefits or in Payment Integrity.At least 5 years participating in healthcare (Medicare, Medicaid, Commercial).At least 5 years of experience with health care data.Experience in project implementation.Skills
Required:Knowledge in CPT, HCPCS, ICD-9, ICD-10, Medicare, and Medicaid rules and regulations.Working knowledge of claims coding and medical terminology.Strong project leadership and management skills; ability to prioritize, plan, and handle multiple tasks simultaneously.Excellent interpersonal, verbal, and written communication skills.Physical Requirements
LightAdditional Information
Salary Range Disclaimer:
The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.This position is a limited duration position with a term of a minimum of one year and a maximum of two years from the start date unless terminated earlier by either party. Limited duration positions are full-time and eligible for full benefits.L.A. Care offers a wide range of benefits including:Paid Time Off (PTO)Tuition ReimbursementRetirement PlansMedical, Dental and VisionWellness Program
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Job Category: ClaimsDepartment: Claims IntegrityLocation: Los Angeles, CA, US, 90017Position Type: Full TimeRequisition ID: 11205Salary Range:
$77,265.00 (Min.) - $100,445.00 (Mid.) - $123,625.00 (Max.)Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan, serving more than 2 million members in five health plans.Mission:
L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities.The Payment Integrity Analyst III is responsible for leading or assisting in vendor implementations and configuration, algorithm/edit customizations, overpayment remediation, and other Payment Integrity functions. This position also supports Payment Integrity solutions focused on trending overpayment and refund reasons to identify and develop a pipeline of new initiatives.Duties
Serves as vendor oversight monitoring to ensure proper submission of files and correct invoicing, as well as monitoring QA metrics to meet all vendor estimates.Serves as SME for all Payment Integrity functions, including both Retrospective Data Mining and Pre-Payment cost avoidance.Supports the creation and execution of strategies that determine the impact of opportunities and recover overpayments.Fields and responds to escalated requests for all inquiries, including Provider Dispute Resolution requests.Identifies and defines Payment Integrity issues, reviews and analyzes evidence, and utilizes data for verification.Serves as a subject matter expert and assists in algorithm/edit customizations and vendor implementations.Performs other duties as assigned.Education Required
Bachelor's Degree. In lieu of degree, equivalent education and/or experience may be considered.Experience
Required:At least 3-5 years of experience in Cost Avoidance and/or Coordination of Benefits or in Payment Integrity.At least 5 years participating in healthcare (Medicare, Medicaid, Commercial).At least 5 years of experience with health care data.Experience in project implementation.Skills
Required:Knowledge in CPT, HCPCS, ICD-9, ICD-10, Medicare, and Medicaid rules and regulations.Working knowledge of claims coding and medical terminology.Strong project leadership and management skills; ability to prioritize, plan, and handle multiple tasks simultaneously.Excellent interpersonal, verbal, and written communication skills.Physical Requirements
LightAdditional Information
Salary Range Disclaimer:
The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.This position is a limited duration position with a term of a minimum of one year and a maximum of two years from the start date unless terminated earlier by either party. Limited duration positions are full-time and eligible for full benefits.L.A. Care offers a wide range of benefits including:Paid Time Off (PTO)Tuition ReimbursementRetirement PlansMedical, Dental and VisionWellness Program
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