Payment Integrity Policy Analyst

Quartz is excited to launch a brand-new Payment Integrity Department, and we're looking for an experienced Medical Coder to help shape this critical function from the ground up. If you're passionate about coding accuracy, payment integrity, and making a meaningful impact on healthcare affordability and quality, this is your opportunity to make a difference for our members and providers.

This role offers a unique chance to influence strategy, develop new policies, and collaborate with a team that truly values both coding expertise and payment integrity excellence.

• Investigate, analyze, develop and implement Payment Integrity Policies

• Research National, Regional, and Local health plans Payment Integrity practices to identify industry trends

• Analyze financial performance of Quartz, provider sponsors, and risk pools

• Reviews, analyzes, and responds to internal or external audits related to Payment Integrity Policies

• Monitor regulatory compliance related to federal, state and ERISA regulations

• Develop provider appeal responses in collaboration with Provider Network Management

• Create educational materials to support provider understanding of Payment Integrity Policies

• Review and respond to escalated provider appeals

• Drive process improvements related to provider abrasion and payment integrity workflows

• Bachelor's degree with 2 years of Payment Integrity, Coding Integrity, or Revenue Integrity Experience

Or

• Associate's degree with 5 years of Experience

Or

• High School equivalency with 8 years of Experience

• Completion of a Medical Coding Program

• Certifications in CPC, COC, RHIT, RHIA, CCA, and/or CCS

• Intermediate to Advanced knowledge in Business Objects and Excel

• Strong Understanding of:

• CMS and Commercial Payer Policies

• Claims Processing and Reimbursement

• ICD-10 Coding & DRG Validation

• Healthcare Revenue Cycle Operations

• Confidence engaging with providers, including discussions at the executive level

Hardware and equipment will be provided by the company, but candidates must have access to high-speed, non-satellite Internet to successfully work from home.

We offer an excellent benefit and compensation package, opportunity for career advancement and a professional culture built on the foundations of Respect, Responsibility, Resourcefulness and Relationships. To support a safe work environment, all employment offers are contingent upon successful completion of a pre-employment criminal background check.

Quartz values and embraces diversity and is proud to be an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, gender identity or expression, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified person with disability.