Payment Integrity Analyst III

HMA is the premier third-party health plan administrator across the PNW and beyond. We relentlessly deliver on our promise to provide medium to large-size employers with customized health plans. We offer various high-quality, affordable healthcare plan options supported with best-in-class customer service.

We are proud to say that for four years, HMA has been chosen as a 'Washington's Best Workplaces' by our Staff and PSBJ. Our vision, 'Proving What's Possible in Healthcare,' and our values, People First!, Be Extraordinary, Work Courageously, Own It, and Win Together, shape our culture, influence our decisions, and drive our results.

What we are looking for: We are always searching for unique people to diversify our team. We only hire people that care deeply about others, thrive in evolving environments, gain satisfaction from being part of a team, are motivated by tackling complex challenges, are courageous enough to share ideas, action-oriented, resilient, and results-driven.

What you can expect: You can expect an inclusive, flexible, and fun culture, comprehensive salary, pay transparency, benefits, and time off package with plenty of personal development and growth opportunities. If you are looking for meaningful work, a clear purpose, high standards, work/life balance, and the ability to contribute to something important, find out more about us at: https://www.accesshma.com/

How YOU will make a Difference:

The Payment Integrity Analyst ensures assigned payment integrity programs are delivered efficiently and with high quality. Using claims expertise, program knowledge, and analytics capability, this person will provide the day-to-day management of assigned programs which may include, but aren't limited to, our CMS Demand Case program and our Subrogation program. They will research case questions, resolve issues, identify process and program improvements, and ultimately contribute to the delivery of a strong portfolio of payment integrity programs.

What YOU will do:

• Manage your assigned programs to meet business objectives and the needs of our clients. As the subject-matter-expert for your assigned programs, you will:
  • Understand program purpose, key stakeholders, primary contract terms, operational processes, and performance metrics.
  • Apply a data-driven approach to ensure programs operate efficiently and deliver expected financial results.
  • Collaborate with cross-functional teams and vendors.
  • Represent programs to internal and external audience, including deliver instructional presentations.
• Manage and improve program operations:
  • Define operational metrics by program and develop methods to monitor them.
  • Deeply understand vendor reporting.
  • Address operational concerns before they become significant issues and own program escalations. Lead cross-functional efforts to define, size, and resolve complex issues efficiently.
  • Identify special handling requirements and execute them in conjunction with internal and external resources.
  • Identify and deliver meaningful operational improvements. Lead efforts with stakeholders to evolve and formalize processes.
• Manage vendor relationships:
  • Foster collaborative relationships with vendors to ensure they value us, our clients, and our members.
  • Be accountable for vendor compliance with key contract terms, operational standards and processes, and performance expectations.
  • Coordinate resources to facilitate vendor requests and changes.
  • Conduct regular business reviews and provide specific feedback to vendor to improve performance.
• Drive program financial growth:
  • Develop metrics and reporting to monitor financial performance.
  • Research industry and vendor competitors, and maintain current knowledge of program areas.
  • Define and present data-driven business cases for new opportunities that will generate higher savings and revenue.
  • Apply project management mindset to deliver new opportunities.

Knowledge, Experience, and Key Attributes needed for Success:

• 5-7+ year of claims processing experience within the insurance industry
• 3-5 years' experience in program management, ideally within a healthcare-related industry.
• Demonstrated experience managing vendor relationships.
• Strong data analysis skills, evidenced by developing effective dashboards and reports to analyze program operations and identify trends, outliers, and opportunities.
• Intermediate Excel skills with the ability to build effective spreadsheets and manipulate data
• Able to manage a complex daily queue and prioritize workload effectively
• Skilled in identifying root causes of issues through detailed investigation and inquiry
• Able to analyze impacts of potential actions or decisions to determine the optimal choice

Compensation:
The base salary range for this position in the greater Seattle area is $39.9/hr - $47.59/hr for a level III and varies dependent on geography, skills, experience, education, and other job or market-related factors. While we are looking for level I, we may consider level II for highly qualified candidates. In addition, HMA provides a generous total rewards package for full-time employees that includes: seventeen (IC) days paid time off; eleven paid holidays, one paid personal and one paid volunteer day; company-subsidized medical, dental, vision, and prescription insurance; company-paid disability, life, and AD&D insurances; voluntary life insurances; HSA and FSA pre-tax programs; 401(k)-retirement plan with company match; wellness incentive and reimbursement; remote work and continuing education reimbursements; discount program; parental leave; and a charitable giving match. For more information about HMA, visit www.accesshma.com.

Disclaimer: The salary, other compensation, and benefits information are accurate as of this posting date. HMA reserves the right to modify this information at any time, subject to applicable law.

In addition, HMA provides a generous total rewards package for full-time employees that includes:

• Seventeen (IC) days paid time off (individual contributors)
• Eleven paid holidays
• Two paid personal and one paid volunteer day
• Company-subsidized medical, dental, vision, and prescription insurance
• Company-paid disability, life, and AD&D insurances
• Voluntary insurances
• HSA and FSA pre-tax programs
• 401(k)-retirement plan with company match
• Annual $500 wellness incentive and a $600 wellness reimbursement
• Remote work and continuing education reimbursements
• Discount program
• Parental leave
• Up to $1,000 annual charitable giving match

How we Support your Work, Life, and Wellness Goals

At HMA, we believe in recognizing and celebrating the achievements of our dedicated staff. We offer flexibility to work schedules that support people in all time zones across the US, ensuring a healthy work-life balance. Employees have the option to work remotely or enjoy the amenities of our renovated office located just outside Seattle with free parking, gym, and a multitude of refreshments. Our performance management program is designed to elevate career growth opportunities, fostering a collaborative work culture where every team member can thrive. We also prioritize having fun together by hosting in person events throughout the year including an annual all hands, summer picnic, trivia night, and a holiday party.

We hire people from across the US (excluding the state of Hawaii and the cities of Los Angeles and San Francisco.)

HMA requires a background screen prior to employment.

Protected Health Information (PHI) Access Healthcare Management Administrators (HMA); employees may encounter protected health information (PHI) in the regular course of their work. All PHI shall be used and disclosed on a need-to-know-basis and according to HMA's standard policies and procedures.

HMA is an Equal Opportunity Employer.

For more information about HMA, visit www.accesshma.com.