Top 16153 Risk Analyst Jobs

Claims Quality Analyst
MetroPlusHealth —New York, NY
- $55,000 - $65,000 a year
- Word processing
- Mid-level
- Continuous improvement
- Commuter assistance
- Paid holidays
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Risk Analyst
Kelly Services —Los Angeles, CA
- $37.84 an hour
- Full-time
- Mid-level
- High school diploma or GED
- Analysis skills
- Paid holidays
- Disability insurance
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Contracts Analyst
BolyːWelch —Portland, OR
- $85,000 - $90,000 a year
- Mid-level
- Office
- Bachelor's degree
- Free parking
- Disability insurance
Risk Analyst
Weitzman —Dallas, TX
- Full-time
- Mid-level
- Organizational skills
- Communication skills
- Free parking
- Health savings account
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12d
Risk Analyst
Clicklease —Draper, UT
- Full-time
- Office
- Finance
- SQL
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12d
Entry Level Business Analyst
ALCglobalSoftware —Remote
- $63,812.09 - $76,848.97 a year
- Full-time
- Remote
- Microsoft Excel
- No background check
- Business Administration
- Health savings account
- Health insurance
Quick Apply
Risk Analyst
Parsons —Remote
- $74,800 - $130,900 a year
- Overtime
- Remote
- Mid-level
- 3 years
- Finance
- Wellness program
- Paid holidays
Program Risk Analyst
AECOM —Dallas, TX
- $65,000 - $118,000 a year
- Full-time
- Remote
- Bachelor of Science
- Mid-level
- Bachelor's degree
- AD&D insurance
- Employee stock purchase plan
Risk Analyst
Fortis —Plano, TX
- Mid-level
- 2 years
- Communication skills
Quick Apply
Analyst - Regulatory Risk
Hard Rock Digital —Hollywood, FL
- Full-time
- Hybrid work
- Mid-level
- Analysis skills
- Communication skills
- Work from home
Quick Apply
Payments Risk Analyst
Certegy Payment Solutions, LLC —Westlake, TX
- Oracle
- Mid-level
- Office
Quick Apply
Cyber Risk Analyst
Hudson Manpower —Cincinnati, OH
- $35 an hour
- Full-time
- Remote
- Mid-level
- Analysis skills
- Bachelor's degree
- Profit sharing
- Paid training
Quick Apply
Investment Risk Analyst
New York Life —New York, NY
- $93,000 - $133,000 a year
- Hybrid work
- Mid-level
- SQL
- Analysis skills
- Loan repayment program
- Adoption assistance
Analyst – Credit Portfolio Analytics – Credit Risk
Morgan Stanley —New York, NY
- $75,000 - $95,000 a year
- Full-time
- Mid-level
- Office
- Analysis skills
Risk and Compliance Analyst
SOSi —Remote
- Full-time
- Remote
- PMP
- 5 years
- Engineering
Quick Apply
Risk Analyst
Westlake Services, LLC —Los Angeles, CA
- $28.84 - $31.25 an hour
- Full-time
- Mid-level
- Office
- Finance
- Paid holidays
- Disability insurance
Quick Apply
Risk Analyst (1919)
Aramco Americas Company —Houston, TX
- Full-time
- Mid-level
- Office
- Analysis skills
Quick Apply
Risk Analyst
Payabli —Miami, FL
- Full-time
- 5 years
- Mid-level
- SQL
- Paid parental leave
- Health savings account
IT Risk & Compliance Analyst
Angi —Denver, CO
- $85,000 - $115,000 a year
- Full-time
- Remote
- Mid-level
- Organizational skills
- 2 years
- Health insurance
- Dental insurance
Quick Apply
Credit Risk Analyst
Boston Portfolio Advisors —Boca Raton, FL
- Mid-level
- Office

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Claims Quality Analyst

MetroPlusHealth -
New York, NY

Quick Apply

Job Details

$55,000 - $65,000 a year

Benefits

Commuter assistance
Paid holidays
Health insurance
Pension plan
Union benefits
Employee discount
Loan forgiveness

Qualifications

Medicare
Managed care
Managed care organization experience
Health insurance policy knowledge
CMS
Medical coding experience in physician offices
CMS regulatory compliance
Quality assurance audits
Medicare regulations
Centers for Medicare & Medicaid Services (CMS) billing regulations
Quality audits
Associate's degree
Healthcare coding investigations
Medical terminology
Analytics

Full Job Description

Empower. Unite. Care.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

About NYC Health + Hospitals

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 40 years, MetroPlusHealth has been committed to building strong relationships with its members and providers.

Position Overview

The Claims Quality Analyst is responsible for reviewing claims to determine if payments have been made correctly. This position analyzes data used in settling claims to determine the validity of payment of claims and reports overpayments, underpayments and other irregularities based upon benefit configuration, compliance with provider contract agreements, and Federal, State and Plan’s established guidelines and/or policies and procedures. The incumbent will research, review, and suggest process improvements, training opportunities and is a resource of information to all staff. The incumbent will also perform special projects.

Work Shifts

9:00 A.M – 5:00 P.M

Duties & Responsibilities

Audit daily processed claims through random selection based on set criteria.
Document, track, and trend findings per organizational guidelines
Based upon trends, determine ongoing Claims Examiner training needs, and assist in the development of training curriculum.
Conduct in-depth research of contract issues, system-related problems, claims processing Policies and Procedures, etc., to confirm cause of trends. Recommend actions/resolutions.
Work with other organizational departments to develop corrective action plans to improve accuracy of the claims adjudication processes and assure compliance with organizational
requirements and applicable regulations
Assist in the development of Claims policies and procedures
Provide backup for other trainers within
the department
Assist in training of new departmental staffs
Assist with the research and resolution of audit appeal
Asist with external/internal regulatory audits
Identify policies or common errors requiring retraining sessions.
Participate in quality projects as required.
Collect, analyze data, identify trends, write reports (i.e., the monthly and quarterly reports) and present findings to the appropriate claims service management personnel.
Other duties as assigned by senior management

Minimum Qualifications

Associate degree required; Bachelor’s degree preferred
Minimum of 4 years of experience performing claims quality audits in a NYS-based managed care setting
Expertise in both professional and institutional claims coding, and coding rules required.
Definitive understanding of provider and health plan contracting, delineation of risk, medical terminology and standard industry reimbursement methodologies required.
Strong knowledge of CMS Medicare and NYS regulations required.
Experience in training development and presentation preferred

Professional Competencies

Strong organizational, analytical, and oral/written communication skills required.
Proficiency in PC application skills, e.g., excel, word, PowerPoint, etc.,
Must be able to follow direction and perform independently according to departmental
Integrity and Trust
Must have excellent interpersonal, verbal, and written communication skills

#LI-Hybrid

#MHP50

Benefits

NYC Health and Hospitals offers a competitive benefits package that includes:

Comprehensive Health Benefits for employees hired to work 20+ hrs. per week
Retirement Savings and Pension Plans
Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts
Loan Forgiveness Programs for eligible employees
College tuition discounts and professional development opportunities
College Savings Program
Union Benefits for eligible titles
Multiple employee discounts programs
Commuter Benefits Programs

Quick Apply

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Risk Analyst jobs

Claims Quality Analyst

Risk Analyst

Contracts Analyst

Risk Analyst

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Risk Analyst

Program Risk Analyst

Risk Analyst

Analyst - Regulatory Risk

Payments Risk Analyst

Cyber Risk Analyst

Investment Risk Analyst

Analyst – Credit Portfolio Analytics – Credit Risk

Risk and Compliance Analyst

Risk Analyst

Risk Analyst (1919)

Risk Analyst

IT Risk & Compliance Analyst

Credit Risk Analyst

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