Payment Integrity Analyst

Job Summary

Reviewing non-emergency medical transportation (NEMT) claims, the full-time Payment Integrity Analyst will identify potential fraud, waste, and abuse, analyze claims for accuracy, and recommend actions based on established payment integrity standards while working remotely.

Key responsibilities

• Reviews submitted NEMT claims for indicators of fraud, waste, abuse, and billing discrepancies
• Analyzes claims and supporting documentation to determine claim validity and recommends appropriate actions
• Collaborates with internal departments to resolve claim issues and support payment integrity initiatives

Required qualifications

• High school diploma required; Bachelor's degree preferred
• Four years of experience in claims analysis, Payment Integrity, or related fields
• Strong analytical and investigative skills with knowledge of payment integrity principles
• Understanding of NEMT claims processing and provider billing practices
• Experience with claims management systems and data analysis tools preferred