Blue Cross & Blue Shield of Rhode Island

Lead Provider Payment Integrity Analyst

Providence, RI

Sponsorship not specified$93k-$139kDetected 30 days ago

SQLStatisticsAccountingExcelProcess ImprovementHRSASCommunicationProblem SolvingClaims Management

About the role

Pay Range: $92,700.00 - $139,100.00 Please email HR_Talent_AcquisitionTeam@bcbsri.org if you are a candidate seeking a reasonable accommodation for the application and/or interview process.
At BCBSRI, our greatest resource is our people.
We come from varying backgrounds, different cultures, and unique experiences.

Create new recurring and ad-hoc reports to identify cost avoidance/overpayment opportunities using large data sets on multiple variables. Provide data, analysis and recommendations to management on all findings affecting payments
Build strong stakeholder relationships and deliver solutions that meet stakeholders' expectations
establish and maintain effective relationships - both internal as well as external.
Develop written reports in accordance with reporting standards. Ensure that all audit findings, exceptions and proposed adjustments to work papers/communication documents are well defined and explained or included in reports.
Perform other duties as assigned.
Create new recurring and ad-hoc reports to identify cost avoidance/overpayment opportunities using large data sets on multiple variables.
Build strong stakeholder relationships and deliver solutions that meet stakeholders' expectations; establish and maintain effective relationships - both internal as well as external.
Ability to manage diverse and deadline-oriented workflow
We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together.
Apply root cause analysis to design and develop solutions to payment integrity opportunities/issues, and coordinate implementation efforts with internal stakeholders as well as vendor(s) and providers as applicable.

Experience using PC SAS (preferably Enterprise Guide SAS), Crystal, SQL, and/or Business Objects.
Proven analytic expertise using Microsoft Excel and Access, database query capabilities, and ability to evaluate data at all levels of detail
Experience with manipulating large datasets
Knowledge of Correct Coding Initiative (CCI) guidelines
Audit skills and the ability to interpret and apply Federal and State regulations, coding and billing requirements.
Demonstrated ability to review analytical, data and audit findings to identify coding trends and risk areas.
Strong organizing skills, with the ability to prioritize and respond to shifting deadlines

Knowledge of diagnostic related groups (DRG's) and American Hospital Association Official Coding Guidelines
Knowledge of Current Procedural Terminology (AAPC Certification preferred)
Familiarity and ability to interpret hospital/provider contracts
Financial/Accounting methodology exposure
Experience with lean or six sigma

We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees.

We provide tuition reimbursement and assist with student-loan repayment.
We offer health, dental, and vision insurance as well as programs that support your mental health and well-being.

Passion, empathy, and understanding are at the forefront of everything we do-not just for our members, but for our employees as well.
Our culture is one of belonging.
We strive to be transparent and accountable.
It's why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off.

$92,700.00 - $139,100.00 Please email HR_Talent_AcquisitionTeam@bcbsri.org if you are a candidate seeking a reasonable accommodation for the application and/or interview process.

This listing is sourced directly from Blue Cross & Blue Shield of Rhode Island's careers page and normalized into a canonical job model.