Payment Integrity Analyst (Healthcare)

TL;DR

Payment Integrity Analyst (Healthcare): Investigating payment errors and recovering improper claim payments using data mining techniques with an accent on medical billing codes and claim verification. Focus on identifying trends in high-volume data sets, validating payment terms, and recommending process improvements to reduce healthcare waste.

Location: Remote (Must be based in the US and legally authorized to work there; no visa sponsorship available)

Salary: $24.20 - $36.30 per hour

Company

AI-first, platform-based healthcare technology company committed to simplifying the business of care by preventing inaccurate payments and reducing overall waste.

What you will do

• Investigate and validate payment terms for Inpatient, Outpatient, and Professional claims using internal systems and payer portals.
• Apply payment policies and coding guidelines (CMS, AMA) to determine correct reimbursement and document rationale.
• Analyze claim inventory and collaborate with teams to configure client-specific business rules.
• Maintain detailed case notes and a library of validation instructions for audit concepts to support downstream recovery.
• Identify root causes of recurring errors and recommend opportunities to streamline research and improve data quality.
• Support payment integrity activities, including recovery, reprocessing, and adjustments, with minimal rework.

Requirements

• Legal authorization to work in the U.S. (No visa sponsorship available).
• Minimum 1 year of experience in healthcare (insurance, claims processing, or fraud, waste and abuse detection).
• Minimum 1 year of experience auditing medical claims to identify improper payments.
• Minimum 1 year of experience performing data analytics with large data sets.
• Proficiency in medical billing codes (CPT, ICD-10-PCS, ICD-10-CM, HCPCS, NDC) and medical terminology.

Nice to have

• Bachelor's degree in business or healthcare-related field.
• Experience with SQL.
• Experience within high-volume, SLA-driven operations teams.
• Knowledge of payment methodologies such as DRG, OPPS, and MIPS.

Culture & Benefits

• Opportunity to work with an AI-first platform shaping the future of healthcare.
• Company recognized as 2025 Best in KLAS for Pre-Payment Accuracy and Integrity.
• Inclusive work environment that embraces collaborative success.
• Strict adherence to HI-TRUST and SOC2 security standards.