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Senior Business Analytics Advisor, Payment Integrity (Remote)CarepathRx • United States
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Senior Business Analytics Advisor, Payment Integrity (Remote)

CarepathRx
  • US
    United States
  • US
    United States
Jetzt Bewerben

Über

Senior Advisor
As a Senior Advisor, you'll provide strategy and analytical support for the Payment Integrity team inclusive of evaluating the current payment integrity programs, from pre-payment and post-payment editing, clinical coding audits, and recovery. You will help translate the payment integrity program performance and results into actionable insights, business cases and identify new savings opportunities. In this role, you will partner across finance, operations, clinical, network, claims, product and vendor teams to drive measurable progress toward enterprise affordability goals. What You'll Do:
Support strategic medical cost analytics by identifying trends, risks, and affordability opportunities across cost containment and payment integrity programs.
Tell the story behind the data, translating complex findings into clear, executive-ready insights for technical, operational, and senior leadership audiences to short the strategic roadmap
Own financial impact assessments and business cases for initiatives, including forecasts, variance analysis, and recommendations to improve performance.
Support program measurement and performance monitoring for pre-payment and post-payment editing, coding audits, and recovery programs across dashboards, scorecards, and executive materials.
Identify and size new opportunities by assessing billing patterns, coding and reimbursement dynamics, and drivers of wasteful or abusive practices.
Partner across the enterprise (e.g., Contracting, Coverage Policy, Commercial Payment Integrity, Compliance, Network Analytics, Claims, Reserving, Product) to align insights to decisions and execution.
Support vendor evaluation and sourcing through data-driven analysis that informs negotiations, pricing structures, and performance guarantees.
Advance reporting and analytics by improving data quality, strengthening controls, and enabling scalable/self-service solutions through automation and thoughtful use of AI-enabled tools.
What You'll Bring:
Proven ability to translate complex analyses into actionable business insights, with clear, confident communication for senior and executive audiences.
Knowledge of reimbursement methodologies and coding (e.g., MS-DRG, APCs, HCPCs, RBRVS) and familiarity with professional and facility claim constructs.
Comfort working in regulated and compliance-aware environments (claims operations, audit programs, policy, and related controls).
Strong collaboration and influence skills, with the ability to balance multiple priorities in a matrixed environment.
Self-starter with a strong orientation toward continuous improvement, ownership, and impact.
Experience modernizing analytics through automation and thoughtful use of AI-enabled and advanced analytics methods (e.g., predictive modeling, NLP, machine learning) where they add measurable value.
Requirements: Bachelor's degree or in a quantitative field (e.g., Economics, Finance, Data Science, Data Analytics, Actuarial Science, Business, Public Health, Applied Mathematics) or equivalent experience
8+ years of progressive experience in healthcare analytics, medical cost analytics, payment integrity, financial modeling, or related fields.
Strong analytical and technical skills, with hands-on experience using tools such as SQL, Excel, SAS, Tableau, Databricks (or similar platforms).
Knowledge of reimbursement methodologies and coding (e.g., MS-DRG, APCs, HCPCs, RBRVS) and familiarity with professional and facility claim constructs.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 112,800 - 188,000 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan.
  • United States

Sprachkenntnisse

  • English
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