Note: The job is a remote job and is open to candidates in USA. Quartz Health Solutions is seeking an experienced health claims/payment integrity professional focused on improving processes that impact payment integrity and performance. The Lead Payment Integrity Analyst will provide lead level support, resolve complex business challenges, and partner with operational leaders to enhance financial performance and compliance.
Responsibilities
- Oversees the financial and key performance indicators related to pre-pay integrity services, post-pay integrity services, premium revenue services, and remediation initiatives to ensure financial and key performance targets are met
- Collaborates with enterprise stakeholders across organization to proactively identify issues and implement resolution strategies
- Partners with Provider Network Management to communicate recovery projects to be informed and respond to questions from providers
- Documents controls, business decisions, and payment integrity oversight to disseminate to the executive team members and Internal Audit Committee
- Ensures accurate interpretation of medical claims trends, payment integrity issues, and process gaps
- Shapes action plans by applying understanding of healthcare regulations, managed care claims workflows, and provider reimbursement model
- Translates strategic needs into clear requirements, workflows, and solutions that drive measurable improvement
- Partners with finance, quality assurance, and compliance to develop business cases and supports reporting that ties operational outcomes to financial targets
Skills
- Bachelor's degree with 6+ years of payment integrity, claims processing, quality or process improvement experience, including performance measurement systems
- OR associate degree with 9+ years of experience of payment integrity, claims processing, quality or process improvement experience, including performance measurement systems
- OR high school equivalency with 12+ years of payment integrity, claims processing, quality or process improvement experience, including performance measurement systems
- Must have experience with: Payment integrity programs
- Health insurance claims processing
- Leading cross-functional workgroups
- Project management
- Lean Six Sigma or problem-solving methodologies
- Strong business judgment
- Strong understanding of claims reimbursement
- Proficient in data analytic tools
- Comfortable interfacing with executives across the organization, and holding cross-functional peers accountable
- Demonstrate ability to manage multiple projects, set priorities, and adhere to committed schedule
- Strong interpersonal skills and adaptive communication style, complex problem-solving skills, drive for results, and innovative
- Strong analytical skills and ability to distill data into actionable results
- Proven track record of delivering results in projects
Benefits
- Robust benefits package
- Hardware and equipment will be provided by the company, but candidates must have access to high-speed, non-satellite Internet to successfully work from home.
- We offer an excellent benefit and compensation package, opportunity for career advancement and a professional culture built on the foundations of Respect, Responsibility, Resourcefulness and Relationships.
- All employment offers are contingent upon successful completion of a pre-employment criminal background check.
Company Overview
Quartz is a locally rooted, provider-owned health plan that connects coverage with care. It was founded in 2016, and is headquartered in Madison, Wisconsin, USA, with a workforce of 501-1000 employees. Its website is https://quartzbenefits.com/.