Payment Cycle Analyst IV is responsible for conducting both systemic and targeted analysis to identify reimbursement errors and to determine root cause.
Collaborating with Configuration, Configuration UAT, Enterprise UAT, IT Claims, and Payment Cycle Team members to ensure test scripts are comprehensive.
Proactively collaborates with various teams to support contracting implementations and resolution of complex claims issues.
Validate MCA Tests for expected results and communicate information to Reimbursement Analysts and HP Managers for provider notification.
Create effective written and oral communication materials that summarize findings and support fact-based recommendations

Bachelor’s degree or equivalent years of relevant work experience is required
Minimum of seven (7) years of health plan experience is required or equivalent experience with health plan operations and configuration
Experience with user testing is required
Experience with payment methodologies and industry pricers (ex: DRG, APC, SNF, RBRVS) is preferred

Payment Cycle Analyst IV

Key skills