Payment Integrity Operations Analyst IV
Medica•,
•$62,700 - $94,080•Remote
About The Position
The Payment Integrity Operations Analyst IV is responsible for supporting and executing payment integrity operations, including program monitoring, data validation, issue identification and resolution, and reporting. This role partners cross-functionally to drive financial accuracy, operational excellence, and a positive provider and member experience. This is a senior-level individual contributor role that also provides guidance to team members and serves as a subject matter expert within payment integrity operations.
Requirements
- Bachelor’s degree or equivalent combination of education and work experience
- 7+ years of relevant professional experience (beyond degree)
- Advanced knowledge of payment integrity, healthcare operations, or related field
- Strong analytical and problem-solving skills with the ability to work on complex issues
- Experience with data analysis, reporting, and operational performance monitoring
- Ability to act as a subject matter expert and provide guidance to others
- Strong communication and cross-functional collaboration skills
- Must be legally authorized to work in the United States at the time of application.
Nice To Haves
- 5+ years of relevant coding experience
- Certified Coder with demonstrated experience in both professional (physician) and facility coding
Responsibilities
- Oversee day-to-day payment integrity operations, ensuring accuracy and efficiency across processes
- Monitor payment integrity programs and analyze performance to identify trends, risks, and improvement opportunities
- Conduct data validation and audits to ensure financial and operational accuracy
- Investigate and resolve complex issues related to claims, payments, and program outputs
- Develop and maintain reporting to support decision-making and operational insights
- Collaborate with cross-functional teams (e.g., operations, analytics, clinical, compliance) to resolve issues and optimize processes
- Provide guidance and direction to team members and support achievement of team goals
- Contribute to process improvements and drive operational best practices
Benefits
- competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services
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What This Job Offers
Job Type
Full-time
Career Level
Senior
