Payment Integrity Specialist Ii

Join Our Team: Do Meaningful Work and Improve People's Lives
Our purpose, to improve customers' lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.
To better serve our customers, we're creating a culture that promotes employee growth, collaborative innovation, and inspired leadership.
Forbes ranked Premera among America's 2023 Best Midsize Employers because we are committed to creating an environment where employees can do their best work and where best-in-class talent comes, stays, and thrives!
As a Payment Integrity Specialist II, you will support the overall objectives of the Payment Integrity Office. This role will support the execution of Premera's corporate wide claim payment accuracy strategy through supporting implementation of new initiatives and serving as a Payment Integrity liaison across multiple internal departments, external vendors, and external health plans. You will collaborate within the Payment Integrity team to address inquiries from internal and external sources related to existing Payment Integrity programs, new initiatives, and Payment Integrity invoicing.
This is a hybrid role, with some onsite days required. You must live within driving distance of our Mountlake Terrace campus, located about 15 miles north of Seattle, Washington.
What you'll do:

• Serve as a subject matter expert for claim payment accuracy including pre-payment claim editing, pre-payment claim auditing, contract compliance, post-payment Payment Integrity solutions, etc.
• Coordinate with vendors, internal teams, and other health plans to maintain Payment Integrity solutions that increase claim payment accuracy.
• Serve as the liaison and primary point of contact for Blue-to-Blue invoicing and vendor invoicing ensuring accurate and timely payment of invoices.
• Collect, analyze, track, and ensure the integrity and timely payment of incoming and outgoing Payment Integrity invoices.
• Effectively respond to Payment Integrity and invoicing inquiries from providers, internal teams, appeals, vendors, and other health plans.
• Participate in technology/tool updates, testing, and troubleshooting with internal teams and external vendors.
• Manage scope of multiple inquiries, projects, or audits under minimal direct supervision.

What you'll bring:

• Bachelor's Degree or (4) years of work experience. (Required)
• (2) years of analytical experience in a technical or business-related discipline, including (1) year of experience participating in medium to large size Payment Integrity projects. (Required)
• Comprehensive knowledge of CPT, ICD10, HCPCS or other coding structures. (Required)
• Proficiency with claim payment accuracy, claims processing, Payment Integrity tools, and claim payment issue resolution.
• Demonstrated ability to effectively use Excel.
• Written communication skills - demonstrated ability to compose sensitive, non-routine correspondence requiring tact and diplomacy.
• Proven experience building and maintaining positive work relationships with internal staff, external vendors, legal teams, state and federal agencies, and external health plans.
• Exceptional analytical skills - demonstrated ability to ensure reliability and relevance of data collected.
• Excellent speaking and presentation skills - demonstrated ability to deliver presentations regarding controversial issues, ability to deliver talks/speeches before groups and audiences.
• Exceptional problem-solving skills - demonstrated ability to solve a wide range of highly complex, multi-disciplinary problems, which must consider long-term company-wide planning.

What we offer

• Medical, vision and dental coverage
• Life and disability insurance
• Retirement programs (401K employer match and pension plan)
• Wellness incentives, onsite services, a discount program and more
• Tuition assistance for undergraduate and graduate degrees
• Generous Paid Time Off to reenergize
• Free parking

Equal employment opportunity/affirmative action:
Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.
If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at careers@premera.com or via phone at 425-918-4785.
Premera is hiring in the following states, with some limitations based on role or city: Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin.
The pay for this role will vary based on a range of factors including, but not limited to, a candidate's geographic location, market conditions, and specific skills and experience.
National Salary Range:
$65,500.00 - $105,800.00
National Plus Salary Range:
$70,300.00 - $119,500.00
*National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska.