Healthcare Payment Integrity Analyst

Bachelor’s degree preferred in Healthcare, Technology, or a related field. 4+ years of experience in healthcare coding, billing, or payment accuracy. National coding credential: CPC, CCS-P, RHIA, CCS, CPB or equivalent. Deep familiarity with CMS policies (LCAs, LCDs, NCDs), CCI edits, OIG alerts, fee schedules. Strong understanding of claims processing workflows (CMS-1500, UB-04). Prior experience developing or managing claims edits. Comfortable collaborating with engineering and product. Intermediate Excel skills (pivot tables, VLOOKUP, functions).

Interpret and translate complex healthcare policies into claims editing logic. Leverage data-driven insights to identify new policy opportunities. Own the development of precise edit specifications in partnership with Engineering. Act as a subject matter expert across Medicaid, Medicare, and commercial lines. Maintain and enhance existing content by monitoring regulatory and policy updates. Ideate and scope policy for clients. Analyze performance data to confirm edit efficacy and document rationale. Collaborate with Product and Engineering to improve tooling and workflows. Independently manage the end-to-end lifecycle of content edits. Stay current on evolving healthcare regulations and coding guidelines. Consistently exceed productivity and quality targets in a remote environment.