State Licensed Senior Analyst

Job Summary

A company is looking for a Senior Analyst, Edits | Payment Integrity (Remote).

Key Responsibilities

• Identify high-impact edit opportunities through claim data analysis and translate medical policy into actionable logic
• Monitor performance metrics and refine edits based on real-world results and compliance with CMS policies
• Collaborate with cross-functional teams to ensure alignment on strategy and present performance insights to leadership

Required Qualifications

• Active coding certification (CCS or CPC) with deep clinical coding expertise
• 5+ years of experience in payment integrity, claims analytics, medical policy, or coding
• Expertise in CPT/HCPCS, ICD-10, DRG, APC/OPPS, and NCCI bundling policies
• Proven experience in prepay editing or post-pay audit logic
• Bachelor's degree in Business, Healthcare, Data Analytics, Public Health, or a related field (or equivalent experience)