Sr. Provider Audit Analyst

Harvard Pilgrim Health Care Inc

Base: $80,607.48 - $120,911.22; bonus/equity: vari...
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Cpt hcpcs icd10-cm code knowledge
Medical claims processing experience
Data mining and analytics skills
** Point32Health is seeking a Sr. Provider Audit Analyst to conduct audits on claims related to coding accuracy and payment policies. The ideal candidate will have extensive healthcare experience, strong analytical skills, and relevant certifications. **

Job Summary

  • The role is accountable for the overall quality and accuracy of assigned individual audits as well as accompanying data mining and summary reporting.
  • Candidates will utilize comprehensive knowledge of CPT, HCPCS, and ICD10-CM codes to assist in claims data analysis related to policies and recovery identification.
  • Point32Health offers a competitive total rewards package including medical, dental, vision coverage, retirement plans, and paid time off.

Matching Summary

Match Score: 75

** Point32Health is seeking a Sr. Provider Audit Analyst to conduct audits on claims related to coding accuracy and payment policies. The ideal candidate will have extensive healthcare experience, strong analytical skills, and relevant certifications. **

Salary

Base: $80,607.48 - $120,911.22; Bonus/Equity: Variable pay eligible; Benefits: Comprehensive total rewards package including medical, dental, vision, and retirement

Skills & Requirements

Must-have

  • CPT HCPCS ICD10-CM code knowledge
  • Medical claims processing experience
  • Data mining and analytics skills
  • SQL or SAS programming proficiency
  • Advanced Excel and MS Access usage

Nice-to-have

  • Critical thinking and organizational skills
  • Ability to function independently
  • Experience with appeals review process
  • Strong communication across departments

Key Requirements

  • Bachelor's degree in related field
  • 5-7 years healthcare experience
  • Coding certification (CPC, CCS or equivalent)

Work Rights

Not specified

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