Payment Integrity Analyst

A Payment Integrity Analyst is responsible for reviewing and auditing healthcare claims to identify errors, fraud, waste, or abuse, ensuring compliance with CMS regulations and health plan policies. Key duties include analyzing medical records for coding accuracy, investigating payment integrity issues, collaborating with internal teams, and preparing detailed audit reports. Candidates should have strong data analysis skills, experience in claims processing, and knowledge of medical coding. This role contributes to cost containment initiatives and requires effective communication of audit findings.