Payment Integrity Analyst

IEHP; Rancho Cucamonga (CA); On-site; USD 80,000 - 106,000; Full time

Benefits offered by this job

Competitive salary

On-site fitness center

Medical insurance

Life insurance

Career advancement

Wellness programs

Flexible Spending Account

CalPERS retirement

457(b) matching

Paid life insurance

Pet care insurance

Job summary

IEHP in Rancho Cucamonga is seeking a Payment Integrity Analyst to use data analytics and regulatory expertise in monitoring overpayment inventory. This role involves collaborating with various teams to identify discrepancies and implement solutions to enhance payment accuracy.

The ideal candidate will have a Bachelor's degree in healthcare or finance, along with 3+ years of relevant experience. The position offers competitive salary and comprehensive benefits.

Qualifications

• 3+ years of experience in healthcare claims processing, billing, or auditing.
• Experience with interpreting contracts and financial responsibilities.
• Strong understanding of medical coding and health insurance contracts.

Responsibilities

• Monitor overpayment inventory and perform claims analysis.
• Collaborate with cross-functional teams to detect inaccuracies.
• Support operational improvements to enhance payment accuracy.

Skills

Data analysis

Medical coding

SQL

Problem-solving

Communication

Trend analysis

Organizational skills

Education

Bachelor's degree in healthcare or finance

Relevant certifications (RHIA, RHIT, etc.)

Tools

Microsoft Office Suite

Job description

What you can expect!

Find joy in serving others with IEHP! We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an authentic experience! Reporting to the Manager, Payment Integrity Operations, the Payment Integrity Analyst monitors the overpayment inventory and performs analysis of claims, coding, contracts, and clinical documentation to identify improper payments, validate audit findings, and develop remediation recommendations and actions. This position leverages data analytics, audit methodologies, and regulatory expertise to detect reimbursement inaccuracies, support overpayment recovery processes, and mitigate future risk. This role collaborates with cross-functional teams including clinical, legal, SIU/FWA, provider relations, and IT to assess patterns of improper spend and implement sustainable solutions. The role maintains audit ready documentation, contributes to business rule enhancements, and supports operational improvements that strengthen payment accuracy and incremental savings opportunities across the claims lifecycle.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Perks

• Competitive salary
• State of the art fitness center on-site
• Medical Insurance with Dental and Vision
• Life, short-term, and long-term disability options
• Career advancement opportunities and professional development
• Wellness programs that promote a healthy work-life balance
• Flexible Spending Account – Health Care/Childcare
• CalPERS retirement
• 457(b) option with a contribution match
• Paid life insurance for employees
• Pet care insurance

Education & Requirements

• A minimum of three (3) years of experience in a combination of healthcare claims processing, billing, and/or auditing functions required
• Experience with contract and Division of Financial Responsibility (DOFR) interpretation. Experience with data analysis/queries experience
• Bachelor’s degree in healthcare, finance, or a related field from an accredited institution required
• In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this position
• This experience is in addition to the minimum years listed in the Experience Requirements above
• Certification in RHIA, RHIT, CCS, CPC, CIC or similar certification preferred

Key Qualifications

• Strong understanding of:
• Medical coding (CPT, ICD-10, HCPCS) and health insurance contracts
• The full claims lifecycle, including share of cost and coordination of benefits
• Medicaid/Medi-Cal or Medicare regulatory frameworks
• Payment integrity concepts (pre-pay audit, post-pay audit types, DRG validation, coordination of benefits and comparable concepts)
• Intermediate in SQL and Microsoft Office Suite (Excel, Access) required
• Demonstrated ability to make independent decisions in claim coding and adjudication
• Strong analytical, problem-solving, and trend analysis skills
• Ability to translate analytical findings into operational recommendations
• Solid organizational and planning capabilities
• Ability to communicate effectively with internal stakeholders and external parties
• Ability to independently prioritize caseloads based on impact and timelines

Pay Range

• $80,059.20 USD Annually - $106,059.20 USD Annually