Payment Integrity Analyst

Location: Remote; US-based employment context indicated by 401(k), Medicaid, HIPAA, and federal and state regulatory requirements

Salary: $24.88–$32.00 per hour

Company

hirify.global provides service-oriented healthcare transportation and related support services, including non-emergency medical transportation.

What you will do

• Review NEMT claims for fraud, waste, abuse, duplicate billing, overpayments, billing discrepancies, and other payment integrity concerns.
• Analyze claims, trip documentation, authorizations, provider records, contracts, and related evidence to determine claim validity.
• Recommend claim approval, denial, adjustment, or recovery based on payment integrity guidelines.
• Document review findings and recommendations accurately in designated systems.
• Identify trends, patterns, and anomalies and refer appropriate cases to the Special Investigations Unit.
• Collaborate with Claims Operations, Compliance, Provider Relations, SIU, leadership, and other internal stakeholders to improve payment integrity controls and audit methods.

Requirements

• High school diploma required; a bachelor's degree is preferred.
• Four years of directly related experience in claims analysis, payment integrity, SIU, or fraud, waste, and abuse investigations.
• Strong analytical, investigative, judgment, communication, and attention-to-detail skills.
• Knowledge of payment integrity principles, FWA detection, NEMT claims processing, provider billing, trip documentation, and authorization processes.
• Ability to analyze large volumes of claims and operational data while meeting productivity, quality, and turnaround expectations.
• Proficiency in Microsoft Office Suite, particularly Excel, with a demonstrated commitment to confidentiality and HIPAA privacy and security requirements.

Nice to have

• Experience with NEMT claims and operations or Medicaid managed care programs.
• Experience with claims management systems and data analysis tools.
• Professional certification in fraud examination, investigations, auditing, or payment integrity.

Culture & Benefits

• Remote full-time work with medical, dental, and vision insurance.
• Employer-paid basic life insurance, AD&D, and short- and long-term disability coverage.
• 401(k) retirement savings plan with company match.
• Paid time off, paid parental leave, tuition reimbursement, and flexible spending accounts.
• Commuter and parking benefits plus employee discounts.