As a Revenue Integrity Administrative Analyst, you will play a crucial role in managing and auditing claims to ensure accuracy and compliance. Key responsibilities include:

• Track and follow up on Stop-loss related claims for various carriers, including sending re-bills and addressing denied claims.
• Audit claims leakage for all Managed Care payors, validate capitation deductions, ensure contractual rates are applied, and provide executive summaries for Stop-loss, TPL, and other recovery items.
• Initiate, track, and follow up on TPL claims, interface with vendors, law firms, providers, and patients, and collaborate with programmers to enhance claims recovery processes.
• Implement processes to identify under-allowed claims, review EOBs for accurate payment postings, verify contracts, analyze variances, and validate underpayments in accordance with payer policies.
• Establish effective contacts with payer offices, inform management of payer performance issues, compile appeals for reimbursement, prepare monthly performance statistics, and participate in meetings to discuss managed care contract trends.
• Maintain confidentiality of medical records and stay current with managed care reimbursement trends.

Salary Range: $30.56-$60.82/hourly