Job Title: Payment Integrity Analyst
Location: Remote. Work EST
Top Skills Required:
Reimbursement Policies and CMS Medicare & Medicaid guidelines
Industry trends on the policies and coding guidelines
Medical Coding - coding audits, DRG audits, COB audits, itemized bill reviews
Analyzing medical claim trends
Analyzing Post-Payment Audit Outcomes
Analyzing Provider Reimbursement policy trends
Identify Payment Integrity Risk and Improvement Opportunities
The Payment Integrity Analyst Post Payment Audits, Claims Analytics & Reimbursement Policy Strategy is responsible for independently analyzing medical claims trends, post payment audit outcomes, and industry-wide provider reimbursement policy trends to identify payment integrity risks and improvement opportunities. This role combines hands-on claims analytics with external market intelligence, requiring the ability to evaluate evolving reimbursement practices across the industry and recommend applicable policies that improve payment accuracy, compliance, and financial integrity.