About this role

Develop requirements for proprietary healthcare edits, conducting comprehensive reviews of contracts, policies, and state/federal guidelines.
Drive collaboration with subject matter experts and technical teams to translate these requirements into functional specifications.
Own the communication of proposed proprietary healthcare edits to internal and external stakeholders.
Create and maintain detailed documentation to support the building and implementation of proprietary healthcare edits.
Provide continuous monitoring and evaluation of the performance of proprietary healthcare edits.

Bachelor’s degree in Healthcare Administration, Business, Finance, Computer Science, or a related field.
Minimum of 3 years of experience in healthcare payment integrity, content & policy, contracts, claims processing, or a closely related field.
Proven track record of developing and implementing proprietary healthcare edits, and/or healthcare content & policy.
Excellent communication and interpersonal skills.
Strong analytical and problem-solving abilities
Experience with documentation management tools and methodologies, such as Confluence or SharePoint.

Senior Payment Integrity Analyst

Key skills