Payment Integrity Analyst

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. Qualifications 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 & ICD‐10 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. Key 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 pursuit of excellence by performing various responsibilities that may arise. Pay Transparency Base pay range: $69,383.00–$92,279.00. MVP Health Care adheres to pay‐transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended individually based on factors such as geographic location, relevant experience, education, and training. MVP's Inclusion Statement MVP Health Care is an equal‐opportunity employer and recruits, employs, trains, compensates, and promotes without discrimination based on race, color, creed, national origin, citizenship, ethnicity, ancestry, sex, gender identity, gender expression, religion, age, marital status, personal appearance, sexual orientation, family responsibilities, familial status, physical or mental disability, handicapping condition, medical condition, pregnancy status, predisposing genetic characteristics or information, domestic violence victim status, political affiliation, military or veteran status, Vietnam‐era or special disabled Veteran or other legally protected classifications. We conduct pre‐employment criminal background checks and drug testing as part of our hiring process. If you require accommodations during the application process due to a disability, please contact our Talent team at [email protected]. #J-18808-Ljbffr