Certified Payment Integrity Analyst

Job Summary

To ensure accuracy and compliance in healthcare claim payments, the full-time Certified Payment Integrity Analyst will lead complex audits, develop claims editing rules, and collaborate with cross-functional teams while working remotely.

Key responsibilities

• Lead complex claim audits and investigations involving high-risk or high-value claims
• Design, develop, and maintain advanced claims editing rules and logic
• Monitor regulatory updates and ensure organizational compliance with healthcare policies

Required qualifications

• Associate's or Bachelor's degree in Health Administration, Public Health, Business, or related field (or equivalent experience)
• 5+ years of experience in healthcare claims, payment integrity, auditing, or revenue cycle
• Advanced expertise in coding systems, reimbursement methodologies, and CMS regulations
• Strong experience with claims editing platforms (e.g., Optum CES) and advanced SQL/data analysis skills
• Certification such as CPC, CCS, or RHIT/RHIA is preferred