Payment Integrity Analyst

Job Summary

To ensure accuracy and compliance in healthcare claim payments, the full-time Payment Integrity Analyst will lead complex claim audits, develop advanced claims editing rules, and collaborate with cross-functional teams, all 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 and reimbursement methodologies
• Strong experience with claims editing platforms (e.g., Optum CES) and SQL data analysis
• One or more relevant certifications such as CPC, CCS, or RHIT/RHIA