Lead Assistant Manager - Claims Resolution and Contract Analyst

EXL Health is looking for a Payment Integrity Claims Resolution and Contract Analyst. This is 100% remote work from home opportunity!

Are you experienced in Payment Integrity Audit Collections and Payer Provider Contracts looking for the next step in your career path? Explore this opportunity with a new, exciting, and dynamic growth-oriented team.

In this role you will collaborate with Payment Integrity Audit program leaders, key client team members, and reporting team members to perform aged claim reconciliation, daily payment verification processing and inventory management.  This role will also abstract information from payer provider contracts and abstract contractual reimbursement terms to build and maintain a Provider Matrix which will support client specific audit & recovery opportunities.  The successful candidate will be passionate, quality focused and have a diverse background in payment integrity audits.

Responsibilities:

• Research audit inventory for aged claim invoicing and collections
• Reconciliation of post audit inventory and reporting
• Daily payment verification processing and reporting
• Identify and assist with implementing process enhancements
• Analyze payer provider contracts to abstract payment terms/requirements to support Payment Integrity audit programs
• Access client’s claim systems to validate claim reimbursement terms
• Maintain a payer/provider matrix

Qualifications:

• 5 years of experience in Payment Integrity Audit Collections
• 5 years or equivalent work experience in healthcare managed care contracts

• Strong analytical skills, with attention to details and ability to problem solve
• Attention to detail and ability to problem solve
• Excellent computer skills with a strong proficiency in excel, word, and outlook

Education and Required Certification:

• Bachelor’s degree or equivalent work experience in payment integrity services

What We Offer:

• EXL Health offers an exciting, fast paced, and innovative environment, which brings together a group of sharp and entrepreneurial professionals who are eager to influence business decisions. From your very first day, you get an opportunity to work closely with experienced, world class Healthcare consultants.
• You can expect to learn many aspects of businesses that our clients engage in. You will also learn effective teamwork and time-management skills - key aspects for personal and professional growth.
• We provide guidance/ coaching to every employee through our mentoring program wherein every junior level employee is assigned a senior level professional as advisors.
• Sky is the limit for our team members. The unique experiences gathered at EXL Health sets the stage for further growth and development in our company and beyond.
• Benefits we offer are Healthcare, Vision, Dental and 401k options.