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Payment Integrity Compliance Specialist in Latham, NY at Beacon Health Options

Date Posted: 1/25/2019

Job Snapshot

Job Description

About The Position:

The Payment Integrity Compliance Specialist will join our team at our office in Woburn, PA, Latham, NY (preferred location), or Remote.  The Payment Integrity Compliance Specialist will be responsible for assisting the implementation of the Payment Integrity Center of Excellence, and other related activities under the direction of the AVP, Payment Integrity.

Position Responsibilities:

  • Conduct behavioral health claims and compliance audits for the purpose of detecting and/or recovering improper benefit payments, and potential fraud, waste, and abuse practices, to ensure compliance with government regulations
  • Conduct analyses of claims data using pivot tables and other tools to identify trends
  • Use existing claims platforms (Flex Care and Connects) to analyze claim recoupments
  • Maintain and distribute accurate and timely audit results, data, and reports
  • Assist Payment Integrity team with expanding the scope and processes of Payment Integrity Center of Excellence by facilitating awareness of coding and billing compliance
  • Assist Payment Integrity team, with meeting ongoing financial objectives for Beacon's negative balance, retro-eligibility, and COB initiatives.
  • Compile and distribute large volumes of communications related to recovery notifications and dispute response notifications.  
  • Maintain turnaround times related to Payment Integrity communications channels, including E-Mail, Fax, and Mail.
  • Facilitate communications with providers and offer technical direction related to administrative functions.
  • Serve in a variety of capacities in representing the department.
  • Assist in the development and presentation of ongoing provider trainings
  • Support payment integrity team and assist with special projects by demonstrating flexibility with daily operations/functions

General Competencies:

  • Flexibility/adaptability: adjusts quickly to changing priorities and conditions; copes effectively with complexity and change
  • Efficiency: able to produce significant output with minimal wasted effort
  • Honesty/Integrity: does not cut corners ethically; earns trust and maintains confidences; does what is right, not just what is politically expedient; speaks plainly and truthfully
  • Proactivity: acts without being told what to do; brings new ideas to the company
  • Analytic skills: able to structure and process qualitative or quantitative data and draw insightful conclusions from it; exhibits a probing mind and achieves penetrating insights
  • Attention to detail: does not let important details slip through the cracks or derail a project
  • Persistence: demonstrates tenacity and willingness to go the distance to get something done
  • Use existing claims platforms (FlexCare and Connects) to analyze claim recoupments
  • Support payment integrity team and assist with special projects by demonstrating flexibility with daily operations/functions

Position Requirements:

  • Education: Some secondary education in healthcare or related experience required.  Bachelor’s degree preferred.
  • Licenses: Certification in coding and/or auditing preferred

Relevant Work Experience:

  • Minimum three–five years of experience in behavioral health-related healthcare, healthcare coding and audit, claims, and/or billing compliance role required
  • Ability to work with large excel data files required
  • Previous program experience with claims, claims edits, claims adjustments, claims programs, payment integrity edits and activities are all desired
  • Current or previous experience with Beacon's claims transactions systems highly desired

To Apply:

Click below on “Apply for this Position” to create a profile and apply for the position

Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment.  EOE/AA/M/F/Veterans/Disabled


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