Medicare SME- Payment Integrity Analyst
Occupations:
Claims Adjusters, Examiners, and InvestigatorsSoftware Quality Assurance Analysts and TestersHealth Informatics SpecialistsInformation Security AnalystsCompensation, Benefits, and Job Analysis SpecialistsIndustries:
Activities Related to Credit IntermediationPipeline Transportation of Natural GasSpecialty Food RetailersElectronic and Precision Equipment Repair and MaintenanceShip and Boat BuildingTitle: Medicare SME- Payment Integrity AnalystDuration : 12 monthsLocation : RemoteThis resource will implement a process to test end-to-end common Medicare Advantage leakage scenarios across multiple Medicare service categories to rapidly determine whether any common issues are relevant at Client NC.TriZetto Facets configuration experience is requiredCollaborate with the team to establish rapid methods to identify current Configuration and payment leakage across key Medicare service categories, and define what is needed to remediate issues quickly across the inputs that support claims payment (medical policy, authorization, benefits, CMS rules, reimbursement policy, provider contracts, fee schedules)Support the following: Complete up-front end-to-end testing to identify leakage requiring remediation, and rapidly determine what is needed to implement fixes, including documentation, implementation, and validation testing.