Hybrid Claims Overpayment Analyst – Lead

at Elevance Health

• Job title: Claims Overpayment Analyst – Lead
• Job type: Full Time
• Experience level: Senior
• Salary: $87,560 - $119,400 per year
• Degree requirement: Bachelor's Degree
• Tech skills: SQL
• Location requirements: Hybrid, Norfolk, United States

About the role

• Claims Overpayment Analyst Lead responsible for analyzing and validating medical overpayments. Working to deliver measurable cost savings through expense recovery and cost avoidance.

Responsibilities

• Develops and executes complex data analysis
• Works with programming staff to ensure requirements will be incorporated into system design and testing
• Perform data mining utilizing CPT, HCPCS, DRG, ICD-9, ICD-10 to identify recovery opportunities
• Provides decision support and procedural input to ensure that processing efficiency does not compromise internal control mechanisms
• Validate overpayments, complete Approach document and forward necessary files and documents for CCU Load
• Documents and responds to any external audit requests
• Ensures proper conversion or shutdown of legacy systems by developing and documenting enterprise solutions for successful transition to core processing systems
• Research all resource documents and web-sites
• Submit enhancement request for database updates

Requirements

• Requires a BA/BS in accounting or finance
• Minimum of 5 years experience in a finance/health insurance field capacity
• Experience with relational databases and report writers
• Project management experience required
• Healthcare business analysis experience preferred
• Experience in using Facets, SQL and MACESS highly preferred
• Medical billing and/or claims processing experience preferred
• 2+ years of experience with data analysis, claims processing, provider billing, FWA investigations, cost containment, Medicare, Medicaid, MMP and/or MedSupp plans strongly preferred
• Medical coding experience - CPT, HCPCS, ICD-9/10 coding preferred
• CPC or applicable professional designation preferred
• Proficient in Microsoft Office products, especially Excel, Word, PowerPoint, Teams, and Outlook strongly preferred
• MBA, CPA, CMA, CFA or applicable professional designation preferred

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution
• Paid holidays
• Paid Time Off
• Medical, dental, vision benefits
• Short and long term disability benefits
• Wellness programs
• Financial education resources