Payment Integrity Analyst

Job Summary

Payment Integrity Analyst is a full-time position responsible for ensuring the accuracy and compliance of healthcare claim payments through auditing, claims editing, and regulatory monitoring.

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 and reimbursement methodologies
• Strong experience with claims editing platforms and advanced SQL/data analysis skills
• Certifications such as CPC, CCS, or RHIT/RHIA preferred