Payment Integrity & Compliance Analyst

Cityblock Health; United States; Remote; USD 70,000 - 82,000; Full time

Benefits offered by this job

Health insurance

Life insurance

Retirement plan

Equity program

Paid time off

Vacation leave

Job summary

Cityblock Health seeks a Payment Integrity Specialist to ensure claims and payments in value-based arrangements are accurate and compliant. You will identify discrepancies, drive recoveries, and implement durable process improvements with finance, actuarial, and clinical teams.

This detail-intensive role blends coding knowledge, data analysis, and CMS/state Medicaid rules, requiring precision and investigative mindset to prevent waste and abuse.

Qualifications

• Experience in payment integrity, claims auditing, or revenue cycle.
• Working knowledge of CPT, HCPCS, ICD-10, DRG coding.
• Familiarity with CMS and state Medicaid reimbursement rules.
• Strong Excel and SQL querying skills.

Responsibilities

• Review claims and encounters against contract terms, policies, CMS and Medicaid guidelines for accuracy.
• Identify overpayments, underpayments, duplicates, and improper payments with clear documentation.
• Reconcile expected vs. actual reimbursement across capitation, value-based, and FFS arrangements.
• Help define and refine payment-integrity edits to catch errors earlier.
• Analyze data to identify trends and support prevention and recovery actions.

Skills

Analytical thinking

Communication

Attention to detail

Education

Bachelor’s degree in finance, healthcare administration, business, health information management, or a related field

Tools

SQL

Excel

Job description

Cityblock Health seeks a Payment Integrity Specialist to ensure claims and payments in value-based arrangements are accurate and compliant. You will identify discrepancies, drive recoveries, and implement durable process improvements with finance, actuarial, and clinical teams.

This detail-intensive role blends coding knowledge, data analysis, and CMS/state Medicaid rules, requiring precision and investigative mindset to prevent waste and abuse.