Financial Operations Analyst Lead- Data Mining Overpayment and Operations​/Payment Integrity- WGS Claims

Financial Operations Analyst Lead
- Data Mining Overpayment and Operations/Payment Integrity- WGS Claims

Title:

Financial Operations Analyst Lead

Hybrid 1:
This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

As a part of the Data Mining Overpayment and Operations team, the Financial Operations Analyst Lead is responsible for analyzing data and providing new processes, system enhancements and technical solutions to complex business issues. Leads and coaches staff. Manages workflow and oversees day-to-day department responsibilities. May conduct operational meetings with staff. Assists management in establishing work goals.

How you will make an impact:

• Develops and executes complex data analysis.
• Develops strategic report applications from Finance systems.
• Provides decision support and procedural input to ensure that processing efficiency does not compromise internal control mechanisms.
• Interfaces with IT as needed to document and track any needed system enhancements.
• Assists in the implementation of Data Science models within the Finance organization.
• Utilizes claims expertise to explain business needs to technical partners.
• Represents department in cross functional and executive meetings.
• Uses discretion in making independent decisions.
• Provide direction and guidance to team members, lead efforts on complex projects, and serve as a subject matter expert for the team.

Minimum Requirements:

• Requires a BA/BS in accounting or finance and a minimum of 5 years' experience in a finance/health insurance field capacity and experience with relational databases and mainframe and client server report writers; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

• Project management experience
• Experience working post-pay reviews, validation, and recovery processes in the healthcare industry
• Experience managing multiple projects in various stages to completion
• Experience with medical billing guidelines, and regulations
• Experience with medical coding systems such as ICD, CPT, and HCPCS
• WGS claims processing experience
• Experience in payment integrity or recovery operations, including leakage analysis
• Knowledge of pricing outcomes, and recovery/concept tools (e.g., PICM, ECM, ACR, CI&W).

Job Level: Non-Management Exempt

Workshift:
Job Family: AFA >
Financial Operations