Payment Integrity Analyst - Data Mining

Location: Remote - US; applicants must already be legally authorized to work in the United States

Salary: $24.20–$36.30 per hour

Company

hirify.global is an AI-first healthcare technology company developing platform-based solutions to prevent inaccurate payments and reduce waste across the healthcare ecosystem.

What you will do

• Review, prioritize, and investigate automated and manual data-mining leads, including moderate-to-complex and high-dollar cases.
• Validate payment terms, policies, contracts, billing codes, and reimbursement across inpatient, outpatient, professional, and ancillary claims.
• Reconcile discrepancies across contracts, eligibility feeds, member and group data, claim history, and third-party responses.
• Document verification steps, evidence, rationale, and outcomes in internal systems to support audits, recovery, reprocessing, adjustments, disputes, and appeals.
• Track error categories and root causes, identify false positives, and recommend improvements to data quality and workflows.
• Use Excel and other tools for trend analysis, inventory quality checks, and performance insights while meeting productivity, turnaround-time, and quality standards.

Requirements

• At least one year of experience in healthcare, health insurance, claims processing or adjudication, or fraud, waste, and abuse detection.
• At least one year of experience auditing medical claims to identify improper payments in a payment integrity vendor or health plan payment integrity team.
• At least one year of experience performing data analytics with large datasets.
• At least one year of experience with CPT, ICD-10-PCS, ICD-10-CM, HCPCS, and NDC codes, medical terminology, DRG, OPPS, and MIPS.
• Legal authorization to work in the United States is required; visa sponsorship and other immigration support are not available.
• Ability to maintain confidentiality and comply with HIPAA and data security standards.

Nice to have

• Bachelor's degree in business, healthcare, or a related field.
• Experience with professional, facility, and ancillary provider payment methodologies or payment integrity auditing concepts.
• Experience with SQL and high-volume, SLA-driven operations.
• Strong written and verbal communication, documentation accuracy, problem-solving, and attention to detail.

Culture & Benefits

• Collaborative environment focused on inclusive work, employee empowerment, and shared success.
• Work in an AI-first healthcare technology organization with established payment integrity expertise.
• Full-time position with base salary compensation and total rewards beyond the listed salary range.
• Company certifications include HITRUST and SOC 2.