Job Description:

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.

Job title:

Senior Business Analyst - Payment Integrity

Job Description:

We are currently hiring a talented Senior Business Analyst to join the Sagility Payment Integrity Solutions team. In this role you will connect with IT and Audit staff to create and present reporting to identify trends, measure audit potential and show opportunities or issues. This role is a strong partner with IT and the Audit team to resolve claims issues, pricing, and fix contract issues.

Key Role Responsibilities:

• Create and present reports.


• Research, design, and develop new reports to assist Audit Team.


• Trouble shoot contract issues and pricing.


• Function as project manager for new features in audit tool/application.


• Serve as a liaison between IT and Audit staff to research, quantify and develop solutions to system issues. Identify trends and audit potential.


• Fix contract pricing issues with Audit staff.


• Other duties as assigned.

Education and Experience:

• Bachelor's degree


• Understanding of claims processing and the lifecycle of a claim.


• 3 plus years of experience with healthcare reporting and analytics required


• Knowledge of healthcare economics


• Experience with CMS inpatient and Outpatient claim regulations


• Experience with State Medicaid pricing.

Qualifications:

• MS SQL experience- Moderate Level,


• Experience with relational and non-relational databases,


• Knowledge OF ICD10, CPT, DRG coding,


• Experience identifying and measuring business trends.


• Project Management experience researching system enhancements,


• Strong people skills to communicate with a wide range of auditor skillsets.


• Strong collaboration skills and ability to work independently and as part of a team.


• Ability to thrive in a fast paced, changing environment.


• Ability to create understanding of and obtain buy in on proposed solutions.


• Knowledge OF ICD10, CPT, DRG coding a strong plus

Sagility Offers Competitive Benefits Including:

• Medical


• Dental


• Vision


• Life Insurance


• Short-Term and Long-Term Disability


• Flexible Spending Account


• Life Assistance Program


• 401K with employer contribution


• PTO and Sick Time


• Tuition Reimbursement

Join our team, we look forward to talking with you!

An Equal Opportunity Employer/Vet/Disability

Location:

Work@Home USAUnited States of America

Apply Now