About Firstsource
Firstsource is a specialized global business process management partner. We provide transformational solutions and services spanning the customer lifecycle across Healthcare, Banking and Financial Services, Communications, Media and Technology, and other diverse industries.
With an established presence in the US, the UK, India, Mexico, Australia, and the Philippines, we act as a trusted growth partner for leading global brands, including several Fortune 500 and FTSE 100 companies.
Job Summary
We are seeking a highly skilled and experienced Configuration Analyst-Payment Integrity to join our team. The ideal candidate will evaluate claims for fraud, waste, and abuse (FWA) prevention and claims auditing in healthcare payer operations.
Key Responsibilities
Analyze submitted medical claims to ensure correct coding using ICD-10, CPT, HCPCS, and modifiers.
Assist in developing and maintaining payment integrity policies and procedures.
Track and monitor claims for compliance with CMS, Medicaid, and commercial payer guidelines.
Implement strategies to mitigate future overpayments, underpayments, and fraud
Evaluate medical documentation to support billed services.
Conduct pre-payment and post-payment claim audits to prevent fraud, waste, and abuse.
Research and apply industry-standard coding and reimbursement methodologies (e.g., NCCI, DRG, APC).
Ensure compliance with payer policies, contracts, and medical necessity requirements.
Utilize claims processing systems and coding audit tools for claim reviews.
Identify trends in billing errors and recommend process improvements.
Stay up to date on coding updates, regulatory changes, and payer policies.
Required Qualifications:
Bachelors degree in healthcare administration, Business, Finance, or a related field preferred.
3+ years of experience in healthcare payment integrity, claims auditing, or fraud detection.
Previous experience in healthcare claims processing, provider reimbursement models, and payment methodologies (fee-for-service, capitation, value-based payments, etc.).
Experience with CMS regulations, state Medicaid rules, and commercial payer compliance.
Proficiency in healthcare fraud analytics, data mining, and predictive modeling.
Knowledge of coding audits (ICD-10, CPT, DRG, HCPCS), medical policies, and utilization management.
Preferred Qualifications:
Certifications such as Certified Professional Coder (CPC), Certified Fraud Examiner (CFE), or AAPC/AHIMA credentials.
Experience with payment integrity platforms, claims analytics tools (e.g., Cotiviti, Optum, Change Healthcare, etc.), and AI-driven fraud detection.
PMP, Six Sigma, or Agile certification.
Firstsource is an Equal Employment Opportunity/Affirmative Action Employer and maintains a Drug-Free Workplace. The companyparticipates in E-Verify and we will provide the Social Security Administration (SSA) and, if necessary, the Department of Homeland Security (DHS), with information from each new employees I-9 to confirm work authorization.
It is the policy of this Company to seek and employ qualified individuals at all locations and facilities, and to provide equal employment opportunities for all applicants and employees in recruiting, hiring, placement, training, compensation, insurance, benefits, promotion, transfer, and termination. To achieve this, we are dedicated to taking affirmative action to employ and advance in employment qualified individuals with disabilities, disabled veterans, and other eligible veterans.
Date Posted: 06 April 2025
Apply for this Job