Sr. Provider Audit Analyst

Point32health Inc

Canton, MA, United States
Base: $80,607.48 - $120,911.22; bonus/equity: not ...
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Claims data analysis
Cpt, hcpcs, icd10-cm codes
Data mining and analytics
** Point32Health is seeking a Sr. Provider Audit Analyst to conduct audits on claims for coding accuracy and compliance. The ideal candidate should possess extensive knowledge of medical claims processing, strong analytical skills, and relevant coding certifications. **

Job Summary

  • The Provider Audit Analyst audits claims for coding accuracy, benefit, payment and contract interpretation in accordance to claims processing guidelines, HPHC Medical and Payment Policies and established audit protocol.
  • Accountable for the overall quality and accuracy of assigned individual audits as well as the accompanying data mining, analytics, and summary reporting, typically managing $.5M to 1M each in recoveries/year.
  • Point32Health offers a competitive and comprehensive total rewards package including medical, dental, vision, retirement plans, paid time off, and well-being benefits.

Matching Summary

Match Score: 75

** Point32Health is seeking a Sr. Provider Audit Analyst to conduct audits on claims for coding accuracy and compliance. The ideal candidate should possess extensive knowledge of medical claims processing, strong analytical skills, and relevant coding certifications. **

Salary

Base: $80,607.48 - $120,911.22; Bonus/Equity: Not specified; Benefits: Medical, dental, vision, retirement plans, paid time off, life and disability insurance, tuition program, well-being benefits

Skills & Requirements

Must-have

  • Claims data analysis
  • CPT, HCPCS, ICD10-CM codes
  • Data mining and analytics
  • Reimbursement policy analysis
  • SAS or SQL programming

Nice-to-have

  • Independent and creative problem-solving
  • Empathy and understanding of diverse needs
  • Continuous improvement identification

Key Requirements

  • 5-7 years of related professional healthcare experience
  • Coding Certification (CPC, CCS or equivalent)
  • Bachelor's degree in a related field
  • Advanced use of MS Access and Excel

Work Rights

Not specified

Tailored Resume

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