Senior Analyst, Quality Assurance and Operations, Payment Integrity at Evolent Health

Remote
Evolent Health

Sr Analyst, QA and Operations, Payment Integrity

Remote, United States

It’s Time For A Change Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely about 40% in year-over-year revenue growth in 2018 . Are we recognized? Definitely. We have been named one of Becker’s 150 Great Places to Work in Healthcare in 2016, 2017, 2018 and 2019, and One of the 50 Great Places to Work in 2017 by Washingtonian. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

Who You’ll Be Working With:

We are looking for an Analyst, QA and Operations to join the Payment Integrity team at Evolent. The PI team focuses on identifying overpayments, performing QA on findings and helps clients recoup overpayments inappropriately paid. The PI team works with various vendors and partners that not only focuses on post-pay identification but conducting a root cause analysis to decrease inappropriate overpayments and implements prepay solutions.

What You’ll Be Doing:

  • Perform QA of data mining, fraud, waste and error concepts identified by Claris
  • Review retraction files and assign them for processing by the funding and recovery team
  • Help develop training and build processes as needed
  • Acting as liaison between Plan/Vendor and Operations team as needed
  • Research discrepancies between identified overpayments and F&R findings
  • Assist across clients as needed
  • Develop and provide training/guidance to ops manager and QA PI team
  • Lead guidance/training/open questions for Pune team
  • Assemble bi-weekly recoup report numbers for PI team and Claris
  • Provide support for F&R when questions or concerns arise
  • Collaborate within the PI team and across other departments to identify issues and craft solutions
  • Identify issues or inconsistencies within data and processes and take initiative to find solutions or correct the problem
  • Other duties as assigned.

The Experience You’ll Need (Required):

  • BA degree OR equivalent combination of education and work experience
  • 7-10 years of extensive healthcare knowledge including Medicare, Medicaid and commercial plans
  • Understanding of claims billing and payment (ICD 9 & ICD 10)
  • Strong critical thinking and analytic skills
  • Able to collaborate with others and work independently on multiple projects at a time
  • Strong written and verbal communication skills

Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.

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