Health Insurance Payment Analyst
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As part of the PERM (Payment Error Rate Measurement) program developed by CMS (Centers for Medicare & Medicaid Services), the Health Insurance Payments Analyst I conducts detailed and precise audits and second-level reviews of claims processing systems across the U.S., onsite at state agencies, and remotely to determine if monies paid by the states were made in accordance with federal and state policies for Medicaid and CHIP.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Essential duties and responsibilities include the following. Other duties may be assigned.
Responsible for the integration of CNI Core Competencies into daily functions, including: commitment to integrity, knowledge/quality of work, supporting financial goals of the company, initiative/motivation, cooperation/relationships, problem analysis/discretion, accomplishing goals through organization, positive oral/written communication skills, leadership abilities, commitment to Affirmative Action, reliability/dependability, flexibility and ownership/accountability of actions taken.
Analyzes federal and state regulations / policies for Medicaid and CHIP reimbursements.
Conducts audits to determine if reimbursements to medical providers were in compliance with regulations and policies.
Conducts second-level reviews of audits made by fellow auditors.
Maintains the confidentiality of patient information in accordance with HIPAA regulations.
Conducts queries and communicates data findings in written and oral reports as well as presentations.
Travels within the U.S. an average of two weeks per month to conduct data processing reviews or provide onsite support.
Responsible for aiding in own self-development by being available and receptive to all training made available by the company.
Plans daily activities within the guidelines of company policy, job description and supervisor's instruction in such a way as to maximize personal output.
Responsible for keeping own immediate work area in a neat and orderly condition to ensure safety of self and co-workers. Will report any unsafe conditions and/or practices to the appropriate supervisor and human resources. Will immediately correct any unsafe conditions to the best of own ability.
Bachelor's degree in a related field and minimum of two years job related experience, or equivalent combination of education / experience. Experience working as a data analyst, auditor, quality control / assurance reviewer, or with Medicaid or other health insurance claims is preferred.
JOB SPECIFIC KNOWLEDGE / SKILLS / ABILITIES
Knowledge of Medicaid programs and Medicaid Management Information Systems (MMIS)
Strong analytical skills with the ability to collect, organize, evaluate and disseminate significant amounts of information
Attentive to detail and accuracy
Demonstrates technical expertise
Proficient in Microsoft Office Suite, in particular Word, PowerPoint, Excel and Outlook
Ability to work well in both a team and independent environment
Demonstrates strong time-management and organizational skills
Excellent communication and interpersonal skills
Ability to collect and analyze complex data, both narrative and statistically
Ability to adapt communications depending on the audience, both technical and non-technical
Excellent project management skills relative to all aspects of planning, organizing and coordinating the project with stakeholders.
Ability to adapt to stressful environments and to utilize problem-solving skills in a demanding environment
CERTIFICATES, LICENSES, REGISTRATION
Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
Ability to read, analyze, and interpret general business periodicals, professiona1journals, technical procedures, and/or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from managers, clients, customers, and the general public.