Medical Economics Analyst-Payment Integrity
About The Position
Presbyterian is hiring a full-time, exempt Medical Economics Analyst-Payment Integrity to join its Payment Integrity team. The role is based remotely in New Mexico and focuses on identifying, quantifying, and validating medical cost savings opportunities through advanced analytics, claims validation, and financial analysis. The analyst will use enterprise claims and provider data to produce actionable insights, validate recoveries, and support pre-pay and post-pay integrity initiatives, while helping ensure payment accuracy and alignment with total cost of care objectives. The position requires technical expertise with SQL and/or SAS, experience working with large healthcare datasets, and the ability to translate analytical findings into clear financial impact. The analyst will collaborate with Payment Integrity, Operations, vendors, and Finance; develop and maintain savings methodologies; build repeatable datasets, analytic pipelines, dashboards, and reporting; and communicate performance, risks, and opportunities to stakeholders. The role also generates pre-payment edit contribution invoices for Self-Funded accounts.
Requirements
- Bachelor’s degree in Actuarial Science, Economics, Finance, Data Analytics, Healthcare Administration, or a related field, or equivalent experience.
- 2–5+ years of experience in healthcare analytics, medical economics, or payment integrity.
- Strong SQL and/or SAS skills; experience querying large relational databases.
- Experience working with claims data and reimbursement methodologies, including fee schedules, IPPS, and OPPS.
- Demonstrated ability to perform financial and statistical analysis on large datasets.
- Strong problem-solving skills, attention to detail, and commitment to data accuracy.
Responsibilities
- Partner with Payment Integrity, Operations, and vendor partners, such as Cotiviti and Optum, to support pre-pay and post-pay initiatives.
- Analyze claims data to identify overpayment patterns, billing anomalies, and coding discrepancies.
- Support development and refinement of rules, algorithms, and audit strategies to improve payment accuracy.
- Translate operational Payment Integrity activities into measurable financial outcomes tied to total cost of care.
- Validate identified savings opportunities through detailed claims-level analysis and audit review.
- Develop and maintain methodologies to quantify gross and net savings from pre-pay edits, post-pay recoveries, and avoidance.
- Perform before-and-after and control-group analyses to support credible savings estimates.
- Partner with Finance to align validated savings with the general ledger and financial reporting.
- Extract, transform, and analyze large-scale healthcare datasets using SQL, SAS, or similar tools.
- Use enterprise data warehouse environments to build repeatable datasets and analytic pipelines.
- Develop dashboards and reporting tools to monitor payment integrity performance and trends.
- Support integration of external and vendor outputs into internal analytics frameworks.
- Produce clear, concise reporting on payment integrity performance, savings, and emerging opportunities.
- Develop executive-ready summaries highlighting key drivers, risks, and recommended actions.
- Support ongoing monitoring of initiative performance and identification of new opportunities.
- Generate pre-payment edit contribution invoices for Self-Funded accounts.
Benefits
- Comprehensive benefits package for benefits-eligible employees, including medical, dental, and vision insurance.
- Short-term and long-term disability insurance.
- Group term life insurance and other optional voluntary benefits.
- Employee Wellness rewards program, with opportunities to earn gift cards by participating in wellness activities.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
