Payment Integrity Analyst

MVP Health Care

2d • $69,383 - $92,279

About The Position

Join Us in Shaping the Future of Health Care At MVP Health Care, we’re on a mission to create a healthier future for everyone. That means embracing innovation, championing equity, and continuously improving how we serve our communities. Our team is powered by people who are curious, humble, and committed to making a difference—every interaction, every day. We’ve been putting people first for over 40 years, offering high-quality health plans across New York and Vermont and partnering with forward-thinking organizations to deliver more personalized, equitable, and accessible care. As a not-for-profit, we invest in what matters most: our customers, our communities, and our team. What’s in it for you: Growth opportunities to uplevel your career A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team Competitive compensation and comprehensive benefits focused on well-being An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work For in the NY Capital District, one of the Best Companies to Work For in New York, and an Inclusive Workplace. You’ll contribute to our humble pursuit of excellence by bringing curiosity to spark innovation, humility to collaborate as a team, and a deep commitment to being the difference for our customers. Your role will reflect our shared goal of enhancing health care delivery and building healthier, more vibrant communities. About This Opportunity This role will support accurate, compliant healthcare reimbursement across our health plan. You’ll perform in‑depth coding reviews, interpret payer and regulatory policy, and contribute to claims editing logic that improves payment accuracy and reduces inappropriate spend.

Requirements

• Bachelor’s degree in healthcare administration, business, or related field preferred; equivalent experience accepted
• Active medical coding certification (CPC, CCS, COC, or equivalent)
• 3+ years of experience working as a certified medical coder
• 4+ years of experience in healthcare coding, billing, or payment accuracy
• Experience with claims processing workflows (CMS-1500, UB-04) and claims editing software.
• Familiarity with CMS policies, CCI edits, OIG alerts, and fee schedules.
• Strong working knowledge of CPT/HCPCS & ICD10 coding, Correct Coding Initiatives, and claims billing.
• Analytical mindset with ability to synthesize data into actionable insights.
• Excellent written and verbal communication skills.
• Intermediate Excel skills (pivot tables, VLOOKUP, functions); SQL skills a plus.
• Ability to manage competing priorities and operate in a fast-paced environment.
• Curiosity to foster innovation and pave the way for growth
• Humility to play as a team
• Commitment to being the difference for our customers in every interaction

Nice To Haves

• SQL skills a plus.

Responsibilities

• Review professional and facility provider claims to ensure coding accuracy and compliant reimbursement
• Apply ICD‑10, CPT, HCPCS, DRGs, modifiers, POA indicators, and revenue codes appropriately
• Interpret and translate CMS, AMA/CPT, and commercial payer policy into actionable claims editing logic
• Partner with engineering and product teams to develop and maintain claims edit specifications
• Analyze claims data to identify trends, discrepancies, and payment process improvement opportunities
• Support customer appeals, audits, and policy reviews by assessing appropriateness of billed services
• Collaborate cross‑functionally to improve tooling, workflows, and content delivery
• Train and advise internal teams and clients on payment integrity best practices and regulatory considerations
• Ensure all reviews and analyses comply with regulatory guidelines and organizational policies
• Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.

Benefits

• Growth opportunities to uplevel your career
• A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team
• Competitive compensation and comprehensive benefits focused on well-being
• An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work For in the NY Capital District, one of the Best Companies to Work For in New York, and an Inclusive Workplace.
• Pay Transparency
• MVP Health Care is committed to providing competitive employee compensation and benefits packages.
• MVP adheres to pay transparency nondiscrimination principles.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 501-1,000 employees