Responsibilities

ThePayment Integrity Analystprovides quality and operational support for PACE program administration,includingclaimsauditingsupport,testing,dataanalysis,issueresolution,systemssupport,and process improvement initiatives. This role supports internal teams, externalpartners, 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.
• Actasaliaisonbetweeninternaldepartments(e.g.,IT,claims,customerservice)and external vendors or PACE program partners.
• MonitorclaimsqualityandintegrityinsystemsandworkwithITorotherteamsto resolve discrepancies.
• Maintaindocumentationofworkflows,businessrules,andprocesschanges.
• Supporttheimplementationofnewlycoveredservicesandupgradesthrough coordination with cross-functional teams.
• Createanddistributereports,provideanalysestosupportbusinessdecisionsandensure compliance with regulatory requirements.
• Assistwithtestingsystemupdatesandenhancements,includinguseracceptancetesting (UAT).
• Identifyprocessimprovementopportunitiesandparticipateininitiativestoenhance operational efficiency and member experience.
• Stay updated on regulatory and industry changes affecting PACE program operations.

TravelRequirement: 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

Bachelor27s degree in healthcare administration, business, or related field, or equivalent work experience.

• 4+yearsofexperienceinclaims healthcareenvironmentorhealthinsurance.
• Stronganalyticalandproblem-solvingskills.
• ProficientinMicrosoftExcel,withexperienceusingdatatoolsandreportingsoftware.
• Excellentwrittenandverbalcommunicationskills.
• Abilitytoworkindependentlyandcollaboratively inafast-pacedenvironment.

Preferred

• Experiencewithpayerhealthplansystems(e.g.,Plexis,Facets,QNXT,EpicTapestry,or similar).
• KnowledgeofHIPAA, Medicare,Medicaid,orACAregulations.
• 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, youll work alongside talented, respectful, and passionate colleagues within a patient-centered care model.

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.

Attention Florida ApplicantsThis position requires a background screening through the Florida Care Provider Background Screening Clearinghouse.For more information, please visit the Clearinghouse Education and Awareness website: https://info.flclearinghouse.com

Agency Disclaimer

InnovAge will not accept unsolicited resumes from search firms for this employment opportunity. Regardless of past practices, all candidates/resumes submitted by search firms to InnovAge by any means without a valid written search agreement in place for that position will be deemed the property of InnovAge and no fee will be paid in the event such candidate is hired by InnovAge.

Fraud Disclaimer

InnovAge is committed to maintaining a safe, transparent, and respectful hiring process for all candidates.

Please be aware that all legitimate email communication regarding InnovAge job opportunities will come exclusively from an email address ending in @innovage.com.

At no point in our hiring process will InnovAge:

• Request payment from candidates for equipment, background checks, onboarding, training, or any other employmentrelated purpose
• Ask for financial information (such as bank account details) before a formal offer and onboarding process is completed through our official systems

If you receive a message claiming to represent InnovAge that does not align with the above, it may be fraudulent. We encourage you to exercise caution and refrain from engaging or sharing personal information.

If you believe you have been contacted by someone misrepresenting InnovAge, please report the activity to [email protected] or apply directly through our official career site to ensure the opportunity is legitimate.

Your trust matters to us, and we appreciate your interest in joining InnovAge.