[Remote] Senior Analyst, Vendor Payment Integrity - Remote

Note: The job is a remote job and is open to candidates in USA. EmblemHealth is a healthcare company seeking a Senior Analyst for Vendor Payment Integrity. The role involves analyzing vendor trends, performing root cause analysis on payment issues, and managing vendor relationships to ensure compliance with contract terms and optimal outcomes.ResponsibilitiesResponsible for analyzing specific contracts in Enterprise Payment IntegrityServe as a primary subject matter expert for each contract to ensure optimal contract management and outcomesEvaluate feasibility of implementing interim workflow processes as a stop gap to provider abrasion and interest paymentsAct as a point of communication and coordination with all internal business units for all issues related to vendor contractsEnsure current and future state analysis is performed, business requirements and change requests are analyzed and accurately documented and aligned with business needsResponsible for “end to end” contract management which includes performing all pre-contractual and implementation activities, business ownership of EPMO and IT projects, development of contract performance standards and associated penalties, root cause analysis and ongoing monitoring and oversightReview content of new Payment Integrity contracts and provide input as appropriatePartner with business and IT to develop testing strategy, test plans and functional test cases. Participate in the development and execution of user test plans to ensure that the system design meets business needsActively participate in all related Policy Meetings, Quarterly Business Reviews, Reimbursement Policy Committees, Steering CommitteesCreate monthly savings reports and identify and address trends in comparison to established goalsSupport budget process by creating requisitions, purchase orders, and accruals for each Payment Integrity program, to ensure program alignment with budgetComplete monthly invoices and reconcile against Oracle system reportingIdentify system enhancements and process improvements which will result in enhanced reporting and savingsApply project management skills to complete related projects and assignmentsInitiate claims to determine under and overpayments, presents outcomes and seeks appropriate business approvalsIdentify and recommend new programs, savings opportunities, and ways to optimize current contractsEvaluate feasibility of implementing interim workflow processes as a stop gap to provider abrasion and interest paymentsComplete assigned Maestro cases in the appropriate Payment Integrity queues to ensure case closure within SLAsEngage vendors and internal business units to review opportunities and lead business case development, savings opportunity analysis, and creation of EPMO or IT related projectsSkillsBachelor's degree4 - 6 years or relevant, professional experience in health care contracting and managementStrong understanding of the healthcare industry, managed care and health plan operationsExperience in managing large, complex contractsAdditional experience/specialized training/certifications may be considered in lieu of educational requirementsKnowledge of accruals, invoicing and financial reportingExperience with performance improvementAbility to prioritize complex projectsExcellent organizational and project management skillsProficiency in Microsoft product suiteExcellent communication skills; ability to interact appropriately/effectively across all departments and management levelsAAPC CPC - AAPC Certified Professional Coder &/or CCS - AHIMA Certified Coding SpecialistMaster's DegreeKnowledge of claims operating platformsCompany OverviewEmblemHealth is an insurance and wellness company that offers health benefits to consumers, employers, and government purchasers. It was founded in 1937, and is headquartered in New York, New York, USA, with a workforce of 1001-5000 employees. Its website is http://www.emblemhealth.com.Company H1B SponsorshipEmblemHealth has a track record of offering H1B sponsorships, with 2 in 2024, 2 in 2023, 2 in 2021, 4 in 2020. Please note that this does not guarantee sponsorship for this specific role.