Payment Integrity Analyst

Job Summary

A company is looking for a Payment Integrity Analyst to ensure accuracy and compliance in healthcare claim payments.

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

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 skills
• One or more relevant certifications such as CPC, CCS, or RHIT/RHIA