Payment Integrity Analyst II: Overpayments & Savings

Texas Children's; Bellaire (TX); On-site; USD 70,000 - 90,000; Full time

Job summary

Texas Children's seeks a Payment Integrity Analyst II to improve claims-payment accuracy, support cost-reduction initiatives, and ensure policy compliance. You will analyze data, identify trends, and collaborate with internal teams and vendors to develop solutions that prevent and recover overpayments.

The role involves reviewing payments for accuracy, supporting remediation activities, and mentoring teammates while coordinating with vendors on implementations and quality assurance.

Qualifications

• Three or more years of health care data experience.
• Two or more years of claims-editing experience with payers or vendors.
• Project implementation experience required.
• Bachelor's degree preferred; CCS/RHIA certifications preferred.

Responsibilities

• Reviews claim payments for accuracy through prepayment edits and post-payment integrity solutions.
• Supports overpayment identification, recovery, remediation, and prevention activities.
• Analyzes overpayment and claims data to identify trends and savings opportunities.
• Develops strategies to recover overpayments and prevent future errors.
• Coordinates with vendors and internal teams to maintain payment-integrity solutions.

Skills

Data analysis

Project implementation

Healthcare payer programs

Education

Bachelor's degree

Certified Coding Specialist (CCS) / RHIA preferred

Job description

Texas Children's seeks a Payment Integrity Analyst II to improve claims-payment accuracy, support cost-reduction initiatives, and ensure policy compliance. You will analyze data, identify trends, and collaborate with internal teams and vendors to develop solutions that prevent and recover overpayments.

The role involves reviewing payments for accuracy, supporting remediation activities, and mentoring teammates while coordinating with vendors on implementations and quality assurance.