Responsibilities

The Payment Integrity Analyst provides quality and operational support for PACE program administration, including claims auditing support, testing, data analysis, issue resolution, systems support, and process improvement initiatives. This role supports internal teams, external partners, and stakeholders to ensure accurate and efficient network operations across claims processing, provider data management, and claims customer services.

Essential Functions and Work Responsibilities
Functional Category: Claims Administration

• Analyze, troubleshoot, and resolve operational issues related to claims, provider networks, and benefits.
• Act as a liaison between internal departments (e.g., IT, claims, customer service) and external vendors or PACE program partners.
• Monitor claims quality and integrity in systems and work with IT or other teams to resolve discrepancies.
• Maintain documentation of workflows, business rules, and process changes.
• Support the implementation of newly covered services and upgrades through coordination with cross-functional teams.
• Create and distribute reports, provide analyses to support business decisions and ensure compliance with regulatory requirements.
• Assist with testing system updates and enhancements, including user acceptance testing (UAT).
• Identify process improvement opportunities and participate in initiatives to enhance operational efficiency and member experience.
• Stay updated on regulatory and industry changes affecting PACE program operations.

Travel Requirement:
n/a

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

Required

Bachelor's degree in healthcare administration, business, or related field, or equivalent work experience.

• 4+ years of experience in claims healthcare environment or health insurance.
• Strong analytical and problem-solving skills.
• Proficient in Microsoft Excel, with experience using data tools and reporting software.
• Excellent written and verbal communication skills.
• Ability to work independently and collaboratively in a fast-paced environment.

Preferred

• Experience with payer health plan systems (e.g., Plexis, Facets, QNXT, Epic Tapestry, or similar).
• Knowledge of HIPAA, Medicare, Medicaid, or ACA regulations.
• SQL or other data query skills a plus.

Benefits

InnovAge is dedicated to empowering seniors to live independently, allowing them to age in their own homes and communities safely. InnovAge offers an alternative to nursing homes through its Program of All-inclusive Care for the Elderly (PACE), which provides enrolled seniors with customized healthcare and social support at PACE Adult Day Health Centers. These centers are staffed by medical professionals who are committed to creating personalized care plans for each participant. At InnovAge, our team members are our greatest asset and have a significant impact on the lives of our participants every day. When you join InnovAge, you'll work alongside talented, respectful, and passionate colleagues within a patient-centered care model.

Salaries are determined by various factors such as qualifications, experience, and location, and do not include potential bonuses or benefits. Our extensive benefits package includes medical/dental/vision insurance, short and long-term disability, life insurance and AD&D, supplemental life insurance, flexible spending accounts, 401(k) savings, paid time off, and company-paid holidays.

Applicants are considered until the position is filled.

Posted Pay Range

$77,400 - $96,800

Additional Information

Compensation Disclaimer

The pay may vary depending on job related factors, such as work location, experience, knowledge, skills, education, certifications, training and internal equity. InnovAge offers a comprehensive benefits package, which includes medical, dental, vision, 401(k) plan with company match, short and long-term disability, life insurance, supplemental life insurance, ADD, flexible spending account, paid time off and company paid holidays.