Job Information
VNS Health Senior Cost Containment Analyst in Manhattan, New York
OverviewCompiles, analyzes, and interprets overpayments through quarterly trend reporting for cost avoidance and recovery initiatives. Co-ordinate with business to align with payment recoveries disseminating findings for affordability initiatives. Conducts analysis of claims and payment data across health plans in support of ensuring payment integrity and cost containment. Identifies anomalous utilization patterns, investigates cost containment, and tests alignment with vendor's contracted rates. Reconciles and validates underlying analytic data claims, and utilization management systems. Tests the integrity of utilization and payment data across plans and functions. Engages in activities to support corrective actions to functions, Operations and Compliance as directed. Works under general supervision
Compensation Range:$77,200.00 - $96,500.00 Annual
What We Provide
Referral bonus opportunities
Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
Employer-matched retirement saving funds
Personal and financial wellness programs
Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
Generous tuition reimbursement for qualifying degrees
Opportunities for professional growth and career advancement
Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities
What You Will Do
Runs cost avoidance reports to analyze and validate managed care claims and comp grids against provider contracts, member eligibility, benefit grids, and authorization data to ensure VNS Health pays our providers appropriately and contains cost.
Investigates utilization and claims coding patterns to identify potential fraud, waste or abuse and coordinates with Compliance and Special Investigation Unit for recoveries as necessary.
Analyzes affordability of medical cost against premium revenue for membership panels of providers, in specific settings, or across other attribution categories as appropriate.
Communicates with internal departments (i.e., Claims, Providers, Finance etc.) to validate existence of integrity leakage points, and coordinates to develop and implement corrective solutions and recovery.
Analyzes recovery and negative balance dashboard validating accuracy, timeliness, and performance of recoveries
Attends meetings with analytics teams, product teams, operations, and allied departments to communicate status of investigative projects and identify new areas of opportunity or priorities. Keeps management informed as necessary.
Utilizes analytic data warehouse and native claims systems and other supporting data for investigation.
Conducts targeted analysis to support regulatory investigations; provides claims extracts and supporting data as required.
Assists encounter team in ensuring alignment of claims to encounters.
Maintains check request and recovery letter trackers assuring reviews are done timely and recovery payments from providers are logged appropriately.
Participates in special projects and performs other duties as assigned.
Qualifications
Education:
- Bachelor's Degree Bachelor’s degree required preferably in Technology, Information Science, Mathematics or Statistics required
Work Experience:
Minimum of three years managed care claims analysis experience. required
Experience in financial or operational analytics. preferred
Knowledge of Medicare and NYS Medicaid claims processing rules and coding experience with DRG, ICD10 and CPT4. required
Proficiency in standard business applications such as Microsoft Office. required
Proficiency in claims processing platforms such as FACETS. required
Proficiency in data analysis software such as SAS, R, or Stata. preferred
Proficiency with SQL. preferred
Excellent communication and analytical skills. required
CAREERS AT VNS Health
The future of care begins with you. Together, we will revolutionize health care in the home and community. When you join VNS Health, you become a part of something bigger. For generations, we’ve been a recognized leader and innovator in patient-centered and community-focused health care. At VNS Health, you’ll have the opportunity to meaningfully impact lives. Including yours. Discover your next role at VNS Health.