Lead Provider Payment Integrity Analyst
Blue Cross & Blue Shield of Rhode Island(2 months ago)
About this role
The role conducts complex, in-depth analysis of medical claim payments and methodologies to identify cost avoidance and overpayment recovery opportunities. The analyst ensures claims compliance with state and federal guidelines, provider contracts, BCBSRI policy, and industry coding standards while coordinating implementation and reporting with internal and external stakeholders.
Required Skills
- Medical Claims
- Data Analysis
- SAS
- SQL
- Excel
- Access
- Audit
- Coding
- Reporting
- Stakeholder Management
Qualifications
- Bachelor's Degree in Business, Healthcare, Finance, Mathematics, Statistics or related
- AAPC Certification (preferred)
About Blue Cross & Blue Shield of Rhode Island
bcbsri.comN/A
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