Payment Integrity Systems Specialist
Job Summary
Managing moderately complex Payment Integrity systems analysis, the full-time Payment Integrity Systems Specialist will perform data validation, reporting, and workflow analysis while working remotely across various states.
Key responsibilities
- Conduct analysis of Payment Integrity platform outputs and claims system data to identify exceptions and trends
- Manage incidents and enhancement requests through documentation, tracking, and coordination of follow-up activities
- Coordinate UAT and regression testing for system changes, ensuring operational impacts are communicated effectively
Required qualifications
- Bachelor's degree in healthcare, business, finance, accounting, information systems, data analytics, or a related field, or equivalent experience
- 2+ years of relevant experience in Payment Integrity systems, data analytics, or related technical healthcare functions
- Working knowledge of managed care claims, Payment Integrity concepts, and operational controls
- Proficiency with Excel and developing proficiency with SQL, Power BI, or similar reporting platforms
- Experience with UAT/testing documentation and cross-functional issue resolution
Complete Job Description
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