Experience Inc. Jobs

Payment Integrity Consultant

Category: Analytics and Emerging Digital Technologies

Main location: United States, Georgia, Atlanta

Position ID: J0724-1975

Employment Type: Full Time

U.S. - Work-life flexibility (https://youtu.be/e0Hkgjlzd2Y)

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Position Description:

CGI is seeking Payment Integrity Consultant for our Emerging Technology team. As a Payment Integrity Consultant, you will be responsible for ensuring accuracy, compliance, and efficiency in healthcare payment processes for CGI Products. You will utilize your expertise in payment integrity operations and healthcare analytics to consult with healthcare payers and providers to analyze existing processes and identify opportunities for process optimization and insourcing processes to reduce medical expense and maximize revenue for claims payment accuracy. Collaborating with various stakeholders, including healthcare providers, payers, and internal teams, you will develop and implement strategies to optimize payment integrity and mitigate financial risks.

Your future duties and responsibilities:

• Conduct comprehensive reviews of healthcare claims, payments, and billing processes to identify inaccuracies, anomalies, and potential instances of fraud, waste, and abuse.

• Stay up-to-date of evolving healthcare regulations, policies, and guidelines related to payment integrity, ensuring adherence to applicable laws such as HIPAA, Medicare, and Medicaid.

• Utilize analytical tools and techniques to detect suspicious patterns and behaviors indicative of fraudulent activities, collaborating with investigative teams to conduct thorough reviews and investigations as needed.

• Identify opportunities for streamlining payment processes, enhancing system efficiencies, and implementing best practices to improve payment accuracy, reduce errors, and optimize financial outcomes.

• Serve as a subject matter expert on payment integrity matters, providing consultation and support to clients, internal teams, and external stakeholders on payment-related inquiries, issues, and initiatives.

• Utilize data analytics tools to analyze payment data, trends, and performance metrics, generating insightful reports and dashboards to communicate findings, recommendations, and insights to key stakeholders.

Required qualifications to be successful in this role:

• Bachelor's degree in healthcare administration, finance, business, or related field; advanced degree preferred

• Six Sigma Black Belt certification preferred

• 10+ years’ experience in healthcare payment integrity, claims auditing, reimbursement analysis, or related field

• Proficiency in data analysis tools and techniques, including SQL, Excel, and data visualization software

• 5+ years’ consulting experience and senior leadership presentations

• Strong analytical, problem-solving, and critical thinking skills, with the ability to interpret complex payment data and identify patterns and trends indicative of potential issues

• Excellent communication and interpersonal skills, with the ability to effectively collaborate with cross-functional teams, clients, and external partners

• Detail-oriented with a commitment to accuracy and compliance, maintaining confidentiality and integrity in handling sensitive payment data and information.

#LI - KB5

Skills:

• Analytical Thinking

What you can expect from us:

Together, as owners, let’s turn meaningful insights into action.

Life at CGI is rooted in ownership, teamwork, respect and belonging. Here, you’ll reach your full potential because…

You are invited to be an owner from day 1 as we work together to bring our Dream to life. That’s why we call ourselves CGI Partners rather than employees. We benefit from our collective success and actively shape our company’s strategy and direction.

Your work creates value. You’ll develop innovative solutions and build relationships with teammates and clients while accessing global capabilities to scale your ideas, embrace new opportunities, and benefit from expansive industry and technology expertise.

You’ll shape your career by joining a company built to grow and last. You’ll be supported by leaders who care about your health and well-being and provide you with opportunities to deepen your skills and broaden your horizons.

Come join our team—one of the largest IT and business consulting services firms in the world.

Qualified applicants will receive consideration for employment without regard to their race, ethnicity, ancestry, color, sex, religion, creed, age, national origin, citizenship status, disability, pregnancy, medical condition, military and veteran status, marital status, sexual orientation or perceived sexual orientation, gender, gender identity, and gender expression, familial status, political affiliation, genetic information, height, weight, or any other legally protected status or characteristics.

CGI provides reasonable accommodations to qualified individuals with disabilities. If you need an accommodation to apply for a job in the U.S., please email the CGI U.S. Employment Compliance mailbox at USEmploymentCompliance@cgi.com . You will need to reference the Position ID of the position in which you are interested. Your message will be routed to the appropriate recruiter who will assist you. Please note, this email address is only to be used for those individuals who need an accommodation to apply for a job. Emails for any other reason or those that do not include a Position ID will not be returned.

We make it easy to translate military experience and skills! Clickhere (https://cgi-veterans.jobs/) to be directed to our site that is dedicated to veterans and transitioning service members.

All CGI offers of employment in the U.S. are contingent upon the ability to successfully complete a background investigation. Background investigation components can vary dependent upon specific assignment and/or level of US government security clearance held. Dependent upon role and/or federal government security clearance requirements, and in accordance with applicable laws, some background investigations may include a credit check. CGI will consider for employment qualified applicants with arrests and conviction records in accordance with all local regulations and ordinances.

CGI will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with CGI’s legal duty to furnish information.