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Payment Integrity Analyst II – Data Mining
Lyric - Clarity in motion.Payment Integrity Analyst II focused on data mining to resolve payment errors. Analyzing claims data and improving operational performance in healthcare payments.
Tech Stack
Tools & technologiesSQL
About the role
Key responsibilities & impact- Supports the Data Mining (DM) program by independently investigating moderate-to-complex payment errors resulting from incorrect processing of payment policies, contract terms, billing, and/or coding to prevent and recover improper claim payments.
- Performs hands-on casework in a high-volume environment, including investigation, documentation, and system updates, while applying advanced analytical skills to interpret claims and reimbursement data, identify trends and false positives, and contribute to concept development and process improvements that enhance accuracy and operational performance within the DM program.
- Operates with increased autonomy, applying judgment to resolve non-routine scenarios, and contributes to improving workflows, logic, and data quality, while collaborating cross-functionally to support scalable payment integrity outcomes.
- Review, prioritize, and independently work assigned DM leads (automated and manual), including moderate-to-complex and high-dollar cases, to determine verification steps and next actions.
- Investigate and validate payment terms (Inpatient, Outpatient, Professional, Ancillary) using internal systems, payer portals, contracts, and other approved data sources.
- Analyze claim inventory from identification to resolution.
- Develop concept overviews and analysis.
- Compile sample claims and supporting documentation for Client review and approval.
- Maintain a library that includes instructions for validating specific audit concepts.
- Create clear, detailed, and accurate case notes that capture verification steps, evidence, and outcomes in internal tools to support audits and downstream recovery/reprocessing.
Requirements
What you’ll need- Minimum of five (5) years of combined experience in healthcare, such as prior work in health insurance, claims processing or adjudication, overpayment, fraud, and/or waste and abuse detection
- Minimum of three (3) years of experience auditing medical claims or performing payment integrity casework, including independent handling of moderately complex scenarios.
- Minimum of three (3) years of experience performing data analysis with large datasets.
- Working knowledge of medical billing codes including but not limited to CPT, ICD-10-PCS, ICD-10-CM, HCPCS, and NDC, as well as an understanding of medical terminology, and prospective payment systems including DRG, OPPS, and MIPS.
- Bachelor's degree in business or healthcare/related field.
- Demonstrated ability to analyze and interpret payment policies, contract terms, and reimbursement methodologies across professional and facility claims.
- Excellent verbal and written communication skills.
- Excellent documentation accuracy and attention to detail.
- Ability to work within established productivity and quality metrics while prioritizing workload with minimal supervision.
- Strong problem-solving skills with the ability to resolve conflicting or incomplete information and escalate appropriately.
- Ability to maintain confidentiality and comply with HIPAA and data security standards.
- Experience supporting audit concept development, validation, or rule refinement within a data mining or payment integrity program.
- Demonstrated experience contributing to process improvement initiatives with measurable impact on accuracy, turnaround time, or false positives.
- Familiarity with contract terms, payment policies, and root cause analysis for payment errors.
- Working knowledge of claim adjudication workflows and payment rules.
- Experience building queries/filters or using reporting tools; basic SQL or query-tool proficiency preferred.
- Experience in high-volume, SLA-driven operations environments.
- Ability to identify trends and translate findings into actionable operational or analytical improvements.
- Creative thinker with an entrepreneurial spirit.
Benefits
Comp & perks- 🌐 Worldwide ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs ✉️ Email Alerts 👤 Account Lyric - Clarity in motion. Website LinkedIn All Job Openings 201 - 500 employees ⚕️ Healthcare Insurance 💳 Fintech ☁️ SaaS Healthcare Insurance
- Fintech
- SaaS Lyric is a leading healthcare technology company focused on payment integrity and accuracy solutions. With over 30 years of experience, Lyric aims to simplify the business of care by leveraging machine learning and predictive analytics to empower health plan payers. The company provides a range of solutions, including Lyric 42 Platform, Pre-Pay Editing, Diagnostics Module, Coordination of Benefits, Concept Libraries, and LyricIQ, which combines AI-powered payment accuracy services. Additionally, Lyric focuses on transparency and responsibility in technology development, ensuring enhanced payment accuracy, administrative efficiencies, and reduced provider abrasion. As a trusted partner in the healthcare industry, Lyric continues to deliver cutting-edge technologies at the crossroads of healthcare and fintech, supporting health plans and providers in the shift to value-based care. Payment Integrity Analyst II – Data Mining Job not on LinkedIn 🔥 0 minutes ago 🇺🇸 United States – Remote 💵 $3.5k - $5.2k / hour ⏰ Full Time 🟡 Mid-level 🟠 Senior 🧐 Analyst Apply Now Find Hiring Managers Customize resume for this job Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 Description
- Supports the Data Mining (DM) program by independently investigating moderate-to-complex payment errors resulting from incorrect processing of payment policies, contract terms, billing, and/or coding to prevent and recover improper claim payments.
- Performs hands-on casework in a high-volume environment, including investigation, documentation, and system updates, while applying advanced analytical skills to interpret claims and reimbursement data, identify trends and false positives, and contribute to concept development and process improvements that enhance accuracy and operational performance within the DM program.
- Operates with increased autonomy, applying judgment to resolve non-routine scenarios, and contributes to improving workflows, logic, and data quality, while collaborating cross-functionally to support scalable payment integrity outcomes.
- Review, prioritize, and independently work assigned DM leads (automated and manual), including moderate-to-complex and high-dollar cases, to determine verification steps and next actions.
- Investigate and validate payment terms (Inpatient, Outpatient, Professional, Ancillary) using internal systems, payer portals, contracts, and other approved data sources.
- Analyze claim inventory from identification to resolution.
- Develop concept overviews and analysis.
- Compile sample claims and supporting documentation for Client review and approval.
- Maintain a library that includes instructions for validating specific audit concepts.
- Create clear, detailed, and accurate case notes that capture verification steps, evidence, and outcomes in internal tools to support audits and downstream recovery/reprocessing. 🎯 Requirements
- Minimum of five (5) years of combined experience in healthcare, such as prior work in health insurance, claims processing or adjudication, overpayment, fraud, and/or waste and abuse detection
- Minimum of three (3) years of experience auditing medical claims or performing payment integrity casework, including independent handling of moderately complex scenarios.
- Minimum of three (3) years of experience performing data analysis with large datasets.
- Working knowledge of medical billing codes including but not limited to CPT, ICD-10-PCS, ICD-10-CM, HCPCS, and NDC, as well as an understanding of medical terminology, and prospective payment systems including DRG, OPPS, and MIPS.
- Bachelor's degree in business or healthcare/related field.
- Demonstrated ability to analyze and interpret payment policies, contract terms, and reimbursement methodologies across professional and facility claims.
- Excellent verbal and written communication skills.
- Excellent documentation accuracy and attention to detail.
- Ability to work within established productivity and quality metrics while prioritizing workload with minimal supervision.
- Strong problem-solving skills with the ability to resolve conflicting or incomplete information and escalate appropriately.
- Ability to maintain confidentiality and comply with HIPAA and data security standards.
- Experience supporting audit concept development, validation, or rule refinement within a data mining or payment integrity program.
- Demonstrated experience contributing to process improvement initiatives with measurable impact on accuracy, turnaround time, or false positives.
- Familiarity with contract terms, payment policies, and root cause analysis for payment errors.
- Working knowledge of claim adjudication workflows and payment rules.
- Experience building queries/filters or using reporting tools; basic SQL or query-tool proficiency preferred.
- Experience in high-volume, SLA-driven operations environments.
- Ability to identify trends and translate findings into actionable operational or analytical improvements.
- Creative thinker with an entrepreneurial spirit. Apply Now 📊 Check your resume score for this job Improve your chances of getting an interview by checking your resume score before you apply. Check Resume Score Similar Jobs Cyber Analyst I 🔥 5 minutes ago AEVEX Aerospace 501 - 1000 🚀 Aerospace 🔒 Cybersecurity Website LinkedIn All Job Openings Entry-level Cybersecurity Analyst ensuring security monitoring and compliance for U.S. national security operations. Collaborating with a managed detection and response team for off-hours coverage. 🇺🇸 United States – Remote 💰 Venture Round on 2020-03 ⏰ Full Time 🟡 Mid-level 🟠 Senior 🧐 Analyst Senior Workday Analyst 🔥 39 minutes ago M&T Bank 10,000+ employees 🏦 Banking 💸 Finance 👥 B2C Website LinkedIn All Job Openings Workday Senior Analyst leading implementation and configuration of Workday solutions. Serving as a subject matter expert in HR-related specialties while collaborating with various business lines. 🇺🇸 United States – Remote 💵 $85.8k - $143k / year ⏰ Full Time 🟠 Senior 🧐 Analyst Commissions Analyst 🔥 1 hour ago Liquid Web 501 - 1000 ☁️ SaaS Website LinkedIn All Job Openings Commissions Analyst at Nexcess handling commission calculations and payroll processes for GTM teams. Driving strategic design of compensation plans to enhance business performance. 🇺🇸 United States – Remote 💵 $70k - $90k / year ⏰ Full Time 🟡 Mid-level 🟠 Senior 🧐 Analyst Claims UAT Analyst 🔥 1 hour ago biBerk Business Insurance 51 - 200 🤝 B2B 💸 Finance Website LinkedIn All Job Openings Claims UAT Analyst leading user acceptance testing across multiple claims systems. Collaborating with IT and business stakeholders to ensure system accuracy and quality. 🇺🇸 United States – Remote 💵 $65k - $80k / year ⏰ Full Time 🟢 Junior 🟡 Mid-level 🧐 Analyst Senior Network Management Analyst 🔥 1 hour ago CVS Health 10,000+ employees ⚕️ Healthcare Insurance 🛒 Retail 🧘 Wellness Website LinkedIn All Job Openings Senior Analyst ensuring accuracy and compliance of pharmacy network pricing implementations at CVS Health. Supporting a Network Pricing team in a high-quality assurance role with multiple deliverables. 🇺🇸 United States – Remote 💵 $47k - $102k / year ⏰ Full Time 🟠 Senior 🧐 Analyst View More Analyst Jobs 🌐 Worldwide Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com Search Search Jobs by country Search jobs by city Search jobs by job title Search entry-level jobs Search junior-level jobs Search senior-level jobs Search jobs by tech stack Search jobs by contract type Search remote internships Search remote part-time jobs Remote jobs Anywhere in the World Companies Hiring Anywhere in the World Companies Hiring Sales People Anywhere in the World Companies Hiring Software Engineers Anywhere in the World Resources Advice Tips for finding remote jobs Interview questions and answers Resume examples Cover letter examples Post a job Affiliates Privacy policy Terms of service Job board SEO course AI Apply Copilot OpenClaw job finder Jobs by Country Remote jobs anywhere in the world (Worldwide remote jobs) Remote jobs United States Remote jobs Australia Remote jobs Brazil Remote jobs Canada Remote jobs France Remote jobs Ireland Remote jobs Germany Remote jobs Netherlands Remote jobs Spain Remote jobs UK Popular Jobs Remote data analyst jobs Remote customer support jobs Remote executive assistant jobs Remote marketing jobs Remote product designer jobs Remote product manager jobs Remote project manager jobs Remote recruiter jobs Remote sales jobs Remote software engineer jobs Jobs by Type Remote full-time jobs Remote part-time jobs Remote contract jobs Remote internship jobs Remote entry-level jobs Remote jobs with no experience required Remote junior jobs (1-3 years of experience) Digital nomad jobs Remote jobs with no degree required Freelance remote jobs Temporary remote jobs Remote jobs hiring now Stay at home mom jobs
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Hard Skills & Tools
data analysismedical billing codesCPTICD-10-PCSICD-10-CMHCPCSNDCDRGOPPSMIPS
Soft Skills
communication skillsdocumentation accuracyattention to detailproblem-solving skillsconfidentialityprocess improvementanalytical thinkingcreativityautonomycollaboration