Summer Intern - Payment Integrity

Job Ref: TE0088
Category: Claims
Department: CLAIMS
Location: 50 Water Street, 7th Floor, New York, NY 10004
Job Type: Temporary
Employment Type: Full-Time
Work Arrangement: Hybrid
Salary Range: $21.00 - $26.00

Empower. Unite. Care.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

About NYC Health + Hospitals

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers.

Position Overview

The Payment Integrity Intern will be responsible for reviewing and analyzing claims to ensure that they meet specific criteria for reimbursement. This includes but not limited to checking for proper documentation and verifying patient eligibility. The ideal candidate will have strong analytical skills and capable to analyze data related to claims and payments to identify trends, discrepancies, or areas for improvement. This involves using software tools to assess large datasets and make meaningful recommendations. Strong communication skills are required, as Payment Integrity requires working closely with other departments, including Claims Operations, Provider Network Relations, Core Configuration and Compliance.

Duties & Responsibilities

• Assist in reviewing and analyzing healthcare claims to ensure accuracy and compliance with policies and regulations.
• Identify and report discrepancies or anomalies in claims data that may indicate billing errors.
• Collaborate with cross-functional teams to resolve payment issues.
• Support the development and implementation of Payment Integrity initiatives aimed at enhancing efficiency.
• Conduct data analysis using software tools to identify trends in claims submissions and payment patterns.
• Prepare detailed reports summarizing findings related to claims accuracy and payment integrity.
• Assist in developing and maintaining payment integrity policies and procedures.

Work Shifts

9:00 AM- 5:00 PM

Minimum Qualifications

• Currently enrolled in a degree program related to healthcare administration, health information management, finance, business administration, data analytics, or related field.
• Students pursuing a bachelor’s degree or higher.
• Strong academic performance, with a focus on analytical and critical thinking skills.

Professional Competencies:

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Written/Oral Communication

#LI-Hybrid