Research Analyst - Medical Management, Remote

Research Analyst – Remote Under the direction of the Head of Providence Health Plan (PHP) Payment Integrity (PI), the Research and Development (R&D) Analyst is responsible for identifying, developing, and implementing solutions to improve the accuracy and integrity of claims payments across the Plan. This role focuses on preventing and reducing unnecessary spending by scoping PI initiatives, analyzing claims data, developing a thorough implementation assessment plan, and collaborating with internal and external stakeholders to optimize the payment processes. This is accomplished by leveraging a deep understanding of Providence Health Plan infrastructure, claims edit and processing platforms, Plan policy, regulatory/compliance, benefit, and contracting functions to synthesize meaningful and actionable PI initiative recommendations. Remote work available for candidates residing in the following states: Oregon Washington California Required Qualifications Bachelor's Degree, or 3 years equivalent experience. 3 years experience with performance improvement/organizational change tools. 3 years experience working with large data sets and analytics teams. 3 years claims processing experience within the health insurance industry. Experience with reimbursement methodologies, including the Centers for Medicare & Medicaid Services (CMS), provider contracts, and medical coding practices. Healthcare experience in project coordination encompassing operations analysis, outcomes measurement methodology, data management and quality improvement process design. Salary Range by Location California – Humboldt: Min: $33.05, Max: $51.30 California – All Northern California (Except Humboldt): Min: $37.08, Max: $57.56 California – All Southern California (Except Bakersfield): Min: $33.05, Max: $51.30 California – Bakersfield: Min: $31.71, Max: $49.22 Oregon – Non-Portland Service Area: Min: $29.56, Max: $45.88 Oregon – Portland Service Area: Min: $31.71, Max: $49.22 Washington – Western: Min: $33.05, Max: $51.30 Washington – Southwest (Olympia, Centralia & Below): Min: $31.71, Max: $49.22 Washington – Eastern: Min: $28.21, Max: $43.80 Washington – Southeast: Min: $29.56, Max: $45.88 Benefits Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well‑being resources and more. Eligibility Notice for Applicants in Unincorporated County of Los Angeles Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. Equal Opportunity Employer Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. #J-18808-Ljbffr