Payment Integrity Value Oversight Analyst

Job Summary

Drives the successful performance of Payment Integrity initiatives by evaluating the financial and operational performance of Payment Integrity results. Works with vendors and other key business areas to address the effectiveness of overpayment prevention solutions and identify potential solution enhancements as necessary. Under minimal supervision and collaborating across multiple teams inspects payment integrity results selection criteria and claim universe while adhering to organizational departmental team and governmental standards and regulations. Performs financial business and workflow analysis to improve Payment Integrity processes. Supports the design of self-service reporting assets to provide data exploration capabilities to end users. Participates in providing operational support for systems and applications troubleshooting and maintenance and ad-hoc support for incidents related to data warehouses data sets and data pipelines. Works with more experienced team members to capture document and groom features and stories for Agile scrum teams. Team members in this position are competent to work self-sufficiently in most activities but require instruction or guidance in others.

Essential Functions

• Performs statistical cost and financial variance analysis of data to evaluate financial performance and identify improvement opportunities. Includes development of forecast models and retrospective assessment of appeals and other adjustments.

• Ensures data used in deliverables is both complete and accurate. Facilitate sharing of payment integrity analysis with multiple stakeholder groups including internal committees regulatory agencies vendors and providers.

• Presents findings to leadership in a manner that convincingly facilitates problem solving and decision making.

• Participates in communications with data consumers with a skill growth mindset to improve performance of processes connecting to data and shares best practices.

• Develops relationships and collaboration across multiple teams to deliver timely and reliable information that enables users to uncover insight from information.

• Participates in data cleansing and profiling to ensure accuracy and quality of information.

• Applies the organizational standards and laws governing use of sensitive data relating to Protected Health Information and Personally Identifiable Information.

• Performs business analysis and workflow analysis in partnership with data consumers to improve performance of Payment Integrity processes connecting to data

• Pursues opportunities to grow their business acumen and skills from more experienced team members. Provides coaching to less experienced team members.

Qualifications

Required

• Required Bachelors degree or equivalent

• 2 years of relevant experience in related field such as business analysis financial analysis or system analysis

Preferred

• Proven analytical skills to assess data and make business recommendations

• Strong Microsoft office skills including Excel

About Corewell Health

As a team member at Corewell Health you will play an essential role in delivering personalized health care to our patients members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators leaders and innovators that continue to build on one shared mission statement - to improve health instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

How Corewell Health cares for you

• Comprehensive benefits package to meet your financial health and work/life balance goals. Learn more here.

• On-demand pay program powered by Payactiv

• Discounts directory with deals on the things that matter to you like restaurants phone plans spas and more!

• Optional identity theft protection home and auto insurance pet insurance

• Traditional and Roth retirement options with service contribution and match savings

• Eligibility for benefits is determined by employment type and status

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CURRENT COREWELL HEALTH TEAM MEMBERS Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.

Corewell Health is committed to providing a safe environment for our team members patients visitors and community. We require a drug-free workplace and require team members to comply with the MMR Varicella Tdap and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process to perform the essential functions of a job or to enjoy equal benefits and privileges of employment due to a disability pregnancy or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race color national origin sex disability age religion genetic information marital status height weight gender pregnancy sexual orientation gender identity or expression veteran status or any other legally protected category.

An interconnected collaborative culture where all are encouraged to bring their whole selves to work is vital to the health of our organization. As a health system we advocate for equity as we care for our patients our communities and each other. From workshops that develop cultural intelligence to our inclusion resource groups for people to find community and empowerment at work we are dedicated to ongoing resources that advance our values of diversity equity and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.486.7447.