Payment Integrity Analyst I

Healthcare Management Administrators

Payment Integrity Analyst managing payment integrity programs for healthcare claims processing. Utilizing analytics and claims expertise to enhance efficiency and quality in HMA's operations.

Posted 7/8/2026full-timeRemote • Washington • 🇺🇸 United StatesMid-LevelSenior💰 $73,000 - $81,000 per yearWebsite

About the role

Key responsibilities & impact

Provide strong analytical, problem-solving and quality assurance skills to support efficient, accurate and timely execution of assigned payment integrity programs
Combine healthcare knowledge and technical skills using programs including QicLink and Excel and reporting from vendor systems to gather, assess, and perform detailed evaluations of data to:
Identify issues, recommend solutions, and manage situations to resolution.
Identify, evaluate and deliver new program improvements that increase cost containment results for HMA and its clients.
Track, manage, and report on daily program inventory for short-term prioritization and long-term strategic planning.
Evaluate existing business processes and policies and develop sustainable, measurable improvements.
Produce clear written documentation to ensure consistent and accurate service provision, such as Procedural Work Instructions or Job Aids for core practices and business requirements for program changes.
Collaborate effectively with internal teams including Appeals, Claims, Client Success, and Stop Loss to deliver an informed, coordinated experience for clients and members.
Interact and communicate effectively with payment integrity program vendors and government agencies to meet program expectations.
Maintain current in knowledge of claims processing, job-related systems, and associated government regulations, and pursue education and training relevant to Payment Analyst role.

Requirements

What you’ll need

High School Diploma required
ICD-10 & CPT experience required
3-5+ year of claims processing experience within the insurance industry
2+ year data entry experience
Intermediate Excel skills with the ability to build effective spreadsheets and manipulate data
Able to manage a complex daily queue and prioritize workload effectively
Skilled in identifying root causes of issues through detailed investigation and inquiry
Able to analyze impacts of potential actions or decisions to determine the optimal choice

Benefits

Comp & perks

Seventeen (IC) days paid time off (individual contributors)
Twelve paid holidays
Two paid personal and one paid volunteer day
Company-subsidized medical, dental, vision, and prescription insurance
Company-paid disability, life, and AD&D insurances
Voluntary insurances
HSA and FSA pre-tax programs
401(k)-retirement plan with company match
Annual $500 wellness incentive and a $600 wellness reimbursement
Remote work and continuing education reimbursements
Discount program
Parental leave
Up to $1,000 annual charitable giving match

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Claims ProcessingData EvaluationRoot Cause AnalysisData ManagementQuality Assurance

Soft Skills

Effective CommunicationCollaborationPrioritizationProblem-Solving