Professional, Overpayment Recovery and Monitoring Analyst
MVP Service 4.6
Remote job
Join Us in Shaping the Future of Health Care
At MVP Health Care, we're on a mission to create a healthier future for everyone. That means embracing innovation, championing equity, and continuously improving how we serve our communities. Our team is powered by people who are curious, humble, and committed to making a difference-every interaction, every day. We've been putting people first for over 40 years, offering high-quality health plans across New York and Vermont and partnering with forward-thinking organizations to deliver more personalized, equitable, and accessible care. As a not-for-profit, we invest in what matters most: our customers, our communities, and our team.
What's in it for you:
Growth opportunities to uplevel your career
A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team
Competitive compensation and comprehensive benefits focused on well-being
An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work For in the NY Capital District, one of the Best Companies to Work For in New York, and an Inclusive Workplace.
You'll contribute to our humble pursuit of excellence by bringing curiosity to spark innovation, humility to collaborate as a team, and a deep commitment to being the difference for our customers. Your role will reflect our shared goal of enhancing health care delivery and building healthier, more vibrant communities.
Qualifications you'll bring:
Bachelor's degree in Health Administration, Business, Economics, Health Informatics, or related field. Associate's degree with the equivalent combination of related experience may also be considered.
Coding certification, such as AAPC CPC, CIC, COC, CCS is required.
The availability to work full-time, virtual in New York State
A minimum of three (3) years' experience in a professional coding environment and three (3) years' experience in auditing and/or reviewing in relevant healthcare industry experience.
Intermediate knowledge of provider reimbursement methodologies and all current coding methodologies.
Intermediate knowledge of Health Insurance and various plan types. Intermediate analytical, problem-solving skills and attention to details.
Ability to initiate education with providers and make internal recommendations for process improvements. Goals and outcomes of the recommendations and education must be measurable.
Curiosity to foster innovation and pave the way for growth
Humility to play as a team
Commitment to being the difference for our customers in every interaction
Your key responsibilities:
Manage recurring audit inventories, ensuring timely progression and completion of existing audits.
Identify and initiate new audits as patterns emerge through risk-based monitoring efforts, datamining, and other routine payment policy reviews.
Analyze new opportunities to substantiate, size, and prioritize audit needs, and develop audit protocols for new audit types.
Report suspected fraud and abuse to the SIU for further investigation and identify providers in need of education.
Collect and validate Key Performance Indicators (KPI's) from payment integrity functions across the organization.
Assist in the reporting of monthly metrics and participate in cross-functional audit operations.
Handle department projects, participate in committees relevant to payment integrity, and support process improvement efforts.
Participate in training and development activities within the department and corporation.
Perform other audit activities and manual reviews as requested, ensuring accuracy of claims and supporting overall payment accuracy.
Perform research using “best practices” in auditing methodologies, remaining current in CPC coding, reimbursement methodologies, MVP Policies and Procedures, and updates in professional literature.
Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.
Where you'll be:
Virtual within New York State
Pay Transparency
MVP Health Care is committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role.
We do not request current or historical salary information from candidates.
$69,383.00-$92,279.00
MVP's Inclusion Statement
At MVP Health Care, we believe creating healthier communities begins with nurturing a healthy workplace. As an organization, we strive to create space for individuals from diverse backgrounds and all walks of life to have a voice and thrive. Our shared curiosity and connectedness make us stronger, and our unique perspectives are catalysts for creativity and collaboration.
MVP is an equal opportunity employer and recruits, employs, trains, compensates, and promotes without discrimination based on race, color, creed, national origin, citizenship, ethnicity, ancestry, sex, gender identity, gender expression, religion, age, marital status, personal appearance, sexual orientation, family responsibilities, familial status, physical or mental disability, handicapping condition, medical condition, pregnancy status, predisposing genetic characteristics or information, domestic violence victim status, political affiliation, military or veteran status, Vietnam-era or special disabled Veteran or other legally protected classifications.
To support a safe, drug-free workplace, pre-employment criminal background checks and drug testing are part of our hiring process. If you require accommodations during the application process due to a disability, please contact our Talent team at ********************.
$69.4k-92.3k yearly Auto-Apply 22d ago
Looking for a job?
Let Zippia find it for you.
Director, Business and Cost Management
Iron Mountain 4.3
Remote job
At Iron Mountain we know that work, when done well, makes a positive impact for our customers, our employees, and our planet. That's why we need smart, committed people to join us. Whether you're looking to start your career or make a change, talk to us and see how you can elevate the power of your work at Iron Mountain.
We provide expert, sustainable solutions in records and information management, digital transformation services, data centers, asset lifecycle management, and fine art storage, handling, and logistics. We proudly partner every day with our 225,000 customers around the world to preserve their invaluable artifacts, extract more from their inventory, and protect their data privacy in innovative and socially responsible ways.
Are you curious about being part of our growth stor y while evolving your skills in a culture that will welcome your unique contributions? If so, let's start the conversation.
Director, Business and Cost Management
This role will build and lead an enterprise-wide business operations function that integrates delivery operations, FinOps governance and customer/project profitability analytics. This leader will be responsible for establishing an end-to-end resource and cost management process and dashboards across cloud infrastructure, on-prem scanning, labor, professional service and cloud costs to enable accurate profitability measurement and operations execution.
This role will partner cross-functionally to modernize how the business measures and manages performance, identifies execution bottlenecks and drives efficiency. Partners include P&L leadership, Finance, Product, Engineering, Customer Success, Professional Services and Support.
Key Responsibilities:
Strategic Leadership
Build and lead a high performing Business Operations team across, Delivery Operations, FinOps, and Cost governance
Champion operational excellence and cross-functional collaboration to improve operational and financial reporting and management and identify opportunities for margin expansion
Serve as a trusted advisor to executive leadership on operational health, risks and strategic opportunities
Business Operations & Performance Management
Own Operational reporting across Operational Delivery, Bus Ops and Service Delivery performance
Drive operating rhythms with regions and functions focused on infrastructure and all cost workstreams
Introduce data-driven decision frameworks that improve forecasting, resourcing, and operational planning
Partner closely with Product, Engineering and Operations to align on new product development and business operational cost impact
Examples:
Oracle PPM roll out
PA model cost inputs
Book to Bill
Cloud cost coordination
Business Operations & Execution Management
Lead operational frameworks for digitization/on-prem scanning services, cloud delivery, labor planning and professional service implementation
Develop standard processes and KPIs focused on optimal performance
Identify execution bottlenecks using workflow analytics and continuous improvement.
Business Operations & Cost Governance
Build and lead end to end BusOps practice covering cost allocations, utilization and consumption forecasting, optimization and governance
Partner with Finance, Cloud Ops and Engineering to create transparent unit economics and cost attribution models
Implement Executive reporting for BusOps cost optimization and programs. Translate complex end to end spend into business insights for executives.
Develop and deliver dashboards and analytics showing real-time and historical spend by BU, region, customer account, service, and product segments
Partner with Cloud Reporting Tool owner (ECS) to ensure reporting governance is accurate and maintained.
Work with Customer Success, Professional Services on confirming active accounts/renewals or decommissioning assets
Profitability Modeling & Analytics
Create unified cost management model that integrates cloud costs, on-prem operations, professional services, hardware/scanning and customer specific delivery costs
Build dashboards that provide customer/project level profitability for executives and field leaders
Deliver insights to support improved pricing, contract structure and product packaging driving transparency so teams can make cost-informed decisions
Build accountability framework that aligns with operational performance and financial outcomes across DBU
Forecasting & Budgeting
Align commercial commitments with operational execution across services, usage, infrastructure and labor.
Align end to end P&L forecasts and actuals with SOW and financial budgets across DBU services lines
Create Governance Controls over regional P&L Chargebacks
Partner with Finance to improve forecast accuracy and reduce variances
Track variances b/w forecast and actual spend to improve accuracy
Change Management
Lead the adoption of Business Operation practices across delivery, FinOps, IT and finance.
Develop and deliver training, communications, and playbooks to build cost awareness
Act as a change champion, influencing stakeholders to adopt cost accountability as a cultural norm
Manage resistance and ensure smooth integration of Business Operations practices into existing workflows
Reasonably expected salary range: $163,400.00 - $217,900.00Category: Administrative Services
$163.4k-217.9k yearly Auto-Apply 4d ago
Disaster Recover Prog Analyst
City National Bank 4.9
Remote job
WHAT IS THE OPPORTUNITY? Information Technology (IT) Disaster Recovery (DR) Program is in the second line of defense and is accountable for CNB's Disaster Recovery strategy, enabling CNB to provide independent oversight and effective review and challenge (R&C) of disaster recovery program. The Disaster Recovery Analyst is responsible for leading disaster recovery risk assessments, providing advice and independent challenge, monitoring metrics/key risk indicators, monitoring regulatory landscape for changes related to IT DR, conducting disaster recovery risk reviews and analysis, and reporting thematic risks to ensure the Disaster Recovery Risk Profile is fairly presented.
WHAT WILL YOU DO?
* Support the development and execution of the IT Disaster Recovery risk program and procedures consistent with City National Bank's and RBC's Risk Framework to ensure a sound control environment from an IT DR/Operational Resilience perspective.
* Key areas of responsibility include R&C of: disaster recovery exercises, IT Datacenter runbooks, IT Disaster Recovery Reporting and adequacy of IT Disaster Recovery controls.
* Monitoring (as needed) of DR tests to confirm adequacy of testing reports and conclusions. Monitoring of DR test may require some evening or weekend work which will be well known and established ahead of time. Working with stakeholders, subject matter experts, and analysis of reports to define issues, determine root cause, and determine appropriate changes.
* Assist with drafting reports and corrective action/remediation plans by providing observations and findings including any gaps in compliance with Bank policies and standards
* Maintain workpapers to support the timely and effective response to requests from Internal Audit or external regulators.
* Performs DR awareness training relating to DR Risk Management, including new and changing policies, systems, and methodologies.
* Assesses DR risks and policy/standard/procedure compliance relating to controls design, FLoD DR testing processes, FLoD DR testing results.
* Provides support of Internal Audits and Regulatory Exams.
* Understand and apply internal policies/procedures, laws and regulations and managing regulatory requirements including but not limited to: FFIEC, OCC, FINRA, Federal Reserve related to Disaster Recovery requirements.
WHAT DO YOU NEED TO SUCCEED?
*Required Qualifications**
* Minimum 7 years practical Business Continuity, Disaster Recovery, and/Crisis Management experience
* Minimum 3 years of financial services experience
* Minimum 3 years of project management experience
*Additional Qualifications*
* BS in Computer Science or demonstrated equivalent experience
* Professional certification from the Disaster Recovery Institute, International or from The Business Continuity Institute (e.g. ABCP, CBCP, MBCP, MBCI, CRP and/or other Business Continuity or industry related certifications preferred.
* Strong skills in applying Disaster Recovery planning principles to various levels (staff, management and executive) of the company.
* Knowledge and understanding of crisis and emergency management.
* Project management skills, which include task identification, project planning, and ability to understand scope of recovery efforts, ability to coordinate critical activities during continuity exercises and events, and proficiency with tools required to pull project together.
* Fully proficient with Microsoft Office applications, including (but not limited to) Word, Excel, Visio, and PowerPoint.
* Advanced presentation skills and oral and written communication skills.
* Self-starter with the ability to work independently.
* Excellent interpersonal, organization, analytical, problem solving, critical thinking, communication, and prioritization skills.
*WHAT'S IN IT FOR YOU?*
*Compensation*Starting base salary: $77,000 - 143,000 per year. Exact compensation may vary based on skills, experience, and location. This job is eligible for bonus and/or commissions.
*Benefits and Perks*
At City National, we strive to be the best at whatever we do, including the benefits and perks we offer our colleagues including:
* Comprehensive healthcare coverage, including Medical, Dental and Vision plans, available the first of the month following start date
* Generous 401(k) company matching contribution
* Career Development through Tuition Reimbursement and other internal upskilling and training resources
* Valued Time Away benefits including vacation, sick and volunteer time
* Specialized health and family planning benefits including fertility benefits, and cancer, diabetes and musculoskeletal support programs
* Career Mobility support from a dedicated recruitment team
* Colleague Resource Groups to support networking and community engagement
Get a more detailed look at our *********************************
ABOUT US
Since day one we've always gone further than the competition to help our clients, colleagues and communities flourish. City National Bank was founded in 1954 by entrepreneurs for entrepreneurs and that legacy of integrity, community and unparalleled client relationships continues today. City National is a subsidiary of Royal Bank of Canada, one of North America's leading diversified financial services companies. To learn more about City National and our dynamic company culture, visit us at **********************************
*INCLUSION AND EQUAL OPPORTUNITY EMPLOYMENT*
City National Bank fosters an inclusive environment where all forms of diversity are valued and leveraged to make us a better company and employer. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identity, national origin, disability, veteran status or other basis protected by law.
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
*Represents basic qualifications for the position. To be considered for this position, you must at least meet the required qualifications. careers.cnb.com accepts applications on an ongoing basis, until filled.
Unless otherwise indicated as fully remote, reporting into a designated City National location is an essential function of the job.
$77k-143k yearly 60d+ ago
Underpayment Recovery Analyst
Trend Health Partners
Remote job
TREND Health Partners is a tech-enabled payment integrity company. Our mission is to facilitate collaboration between payers and providers for mutual benefit and waste reduction, ultimately improving access to healthcare. We achieve this by aligning the common goals of payers and providers and fostering collaboration through a shared technology platform and seamless workflows.Joining TREND Health Partners means becoming part of a dynamic, growing organization that promotes a collaborative and innovative work environment. Our comprehensive compensation package includes competitive salaries, highly valued health insurance, a 401(k) plan with employer match, paid parental leave, and more.
The Underpayment Recovery Analyst is responsible for the timely and accurate review, identification, and resolution of underpaid hospital claims. This role plays a critical part in optimizing client reimbursement by conducting detailed analyses of claim-level payments, following up with payers, and preparing appeals to address single-instance and systemic underpayments. The ideal candidate brings deep expertise in hospital payer contracts, reimbursement methodologies, and denial management, and will contribute to internal performance targets and client satisfaction.
Role and Responsibilities
CLAIMS REVIEW AND ANALYSIS
Perform detailed analysis of remittances, explanations of benefits (EOBs),payer correspondence, and account detail to identify underpayments or incorrect claim adjudications.
Evaluate claim payment variances against expected reimbursements based on client-specific contract terms.
Accurately identify and categorize underpayment types and root causes (e.g., pricing discrepancies, DRG/APC miscalculations, bundling errors, inappropriate denials).
PAYER FOLLOW UP AND APPEALS
Initiate rebilled or corrected claims and manage timely follow-up on outstanding underpaid or denied claims.
Prepare and submit detailed appeals with appropriate documentation and contract references to secure accurate reimbursement.
Track outcomes and escalate unresolved issues as needed.
CONTRACTUAL EXPERTISE
Interpret complex hospital managed care contracts, fee schedules, payer policies, and government payer reimbursement policies.
Validate expected reimbursement across multiple payer types (e.g., Medicare Advantage, Medicaid, Commercial).
ROOT CAUSE AND TREND IDENTIFICATION
Identify and document systemic payer issues and trends affecting reimbursement.
Partner with internal teams and client stakeholders to recommend process improvements, payer escalations, or system configuration changes.
PERFORMANCE QUALITY
Meet or exceed established internal Key Performance Indicators (KPIs) related to claims reviewed, identifications, recovery amounts, appeal turnaround times, and accuracy.
Maintain up-to-date and organized case documentation in internal systems and client-facing portals.
Qualifications
Experience in healthcare revenue cycle, with a strong focus on underpayment/zero balance review, and payer reimbursement analysis.
Understanding of hospital managed care contracts and reimbursement methodologies (e.g., DRG, APC, percent-of-charge, per diem).
Experience with contract modeling tools and hospital billing systems (e.g., Epic, Cerner, Meditech).
Knowledge of payer-specific policies, billing regulations, and denial types (technical and clinical), payer-specific portals and dispute resolution processes.
Knowledge of CMS, Medicare Advantage, and state Medicaid plan rules.
Strong analytical skills with the ability to interpret complex data and identify trends or discrepancies.
Excellent written and verbal communication skills
Proficient in Microsoft Excel and other data analysis/reporting tools.
Mental and physical demands
This position will be exposed mainly to an indoor office environment and will be expected to work in or around computers and printers.
The nature of the work is sedentary, and the employee will be sitting most of the time.
Essential physical functions of the job include typing and the repetitive motion to utilize computer software and hardware continuously throughout the day.
Essential mental functions of this position include concentrating on analytical tasks, reading information, and verbal/written communication to others continuously throughout the day.
Related duties as assigned
This job description documents the general nature and level of work but is not intended to be a comprehensive list of activities, duties, or responsibilities required for this position. Consequently, employees may be asked to perform other duties as required.
Employees may also be asked to complete certain compliance requirements set forth by our Business Partners in the performance of their jobs including but not limited to requests for background and drug screenings and disclosures of personal health information or personally identifiable information. Exemptions as provided under the ADA and TITLE VII of the Civil Rights Act will be observed and followed.
Reasonable accommodations may be made to enable individuals with disabilities to perform the functions outlined above.
$50k-74k yearly est. Auto-Apply 24d ago
Disaster Recover Prog Analyst
City National Bank 4.9
Remote job
WHAT IS THE OPPORTUNITY? Information Technology (IT) Disaster Recovery (DR) Program is in the second line of defense and is accountable for CNB's Disaster Recovery strategy, enabling CNB to provide independent oversight and effective review and challenge (R&C) of disaster recovery program. The Disaster Recovery Analyst is responsible for leading disaster recovery risk assessments, providing advice and independent challenge, monitoring metrics/key risk indicators, monitoring regulatory landscape for changes related to IT DR, conducting disaster recovery risk reviews and analysis, and reporting thematic risks to ensure the Disaster Recovery Risk Profile is fairly presented.
WHAT WILL YOU DO?
* Support the development and execution of the IT Disaster Recovery risk program and procedures consistent with City National Bank's and RBC's Risk Framework to ensure a sound control environment from an IT DR/Operational Resilience perspective.
* Key areas of responsibility include R&C of: disaster recovery exercises, IT Datacenter runbooks, IT Disaster Recovery Reporting and adequacy of IT Disaster Recovery controls.
* Monitoring (as needed) of DR tests to confirm adequacy of testing reports and conclusions. Monitoring of DR test may require some evening or weekend work which will be well known and established ahead of time. Working with stakeholders, subject matter experts, and analysis of reports to define issues, determine root cause, and determine appropriate changes.
* Assist with drafting reports and corrective action/remediation plans by providing observations and findings including any gaps in compliance with Bank policies and standards
* Maintain workpapers to support the timely and effective response to requests from Internal Audit or external regulators.
* Performs DR awareness training relating to DR Risk Management, including new and changing policies, systems, and methodologies.
* Assesses DR risks and policy/standard/procedure compliance relating to controls design, FLoD DR testing processes, FLoD DR testing results.
* Provides support of Internal Audits and Regulatory Exams.
* Understand and apply internal policies/procedures, laws and regulations and managing regulatory requirements including but not limited to: FFIEC, OCC, FINRA, Federal Reserve related to Disaster Recovery requirements.
WHAT DO YOU NEED TO SUCCEED?
*Required Qualifications**
* Minimum 7 years practical Business Continuity, Disaster Recovery, and/Crisis Management experience
* Minimum 3 years of financial services experience
* Minimum 3 years of project management experience
*Additional Qualifications*
* BS in Computer Science or demonstrated equivalent experience
* Professional certification from the Disaster Recovery Institute, International or from The Business Continuity Institute (e.g. ABCP, CBCP, MBCP, MBCI, CRP and/or other Business Continuity or industry related certifications preferred.
* Strong skills in applying Disaster Recovery planning principles to various levels (staff, management and executive) of the company.
* Knowledge and understanding of crisis and emergency management.
* Project management skills, which include task identification, project planning, and ability to understand scope of recovery efforts, ability to coordinate critical activities during continuity exercises and events, and proficiency with tools required to pull project together.
* Fully proficient with Microsoft Office applications, including (but not limited to) Word, Excel, Visio, and PowerPoint.
* Advanced presentation skills and oral and written communication skills.
* Self-starter with the ability to work independently.
* Excellent interpersonal, organization, analytical, problem solving, critical thinking, communication, and prioritization skills.
*WHAT'S IN IT FOR YOU?*
*Compensation*Starting base salary: $77,000 - 143,000 per year. Exact compensation may vary based on skills, experience, and location. This job is eligible for bonus and/or commissions.
*Benefits and Perks*
At City National, we strive to be the best at whatever we do, including the benefits and perks we offer our colleagues including:
* Comprehensive healthcare coverage, including Medical, Dental and Vision plans, available the first of the month following start date
* Generous 401(k) company matching contribution
* Career Development through Tuition Reimbursement and other internal upskilling and training resources
* Valued Time Away benefits including vacation, sick and volunteer time
* Specialized health and family planning benefits including fertility benefits, and cancer, diabetes and musculoskeletal support programs
* Career Mobility support from a dedicated recruitment team
* Colleague Resource Groups to support networking and community engagement
Get a more detailed look at our *********************************
ABOUT US
Since day one we've always gone further than the competition to help our clients, colleagues and communities flourish. City National Bank was founded in 1954 by entrepreneurs for entrepreneurs and that legacy of integrity, community and unparalleled client relationships continues today. City National is a subsidiary of Royal Bank of Canada, one of North America's leading diversified financial services companies. To learn more about City National and our dynamic company culture, visit us at **********************************
*INCLUSION AND EQUAL OPPORTUNITY EMPLOYMENT*
City National Bank fosters an inclusive environment where all forms of diversity are valued and leveraged to make us a better company and employer. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identity, national origin, disability, veteran status or other basis protected by law.
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
*Represents basic qualifications for the position. To be considered for this position, you must at least meet the required qualifications. careers.cnb.com accepts applications on an ongoing basis, until filled.
Unless otherwise indicated as fully remote, reporting into a designated City National location is an essential function of the job.