Remote Medical Economics Analyst – Payment Integrity

Presbyterian Healthcare Services; Santa Fe (NM); Remote; USD 88,000 - 149,000; Full time

Benefits offered by this job

Medical benefits

Wellness program

Gift cards

Job summary

Presbyterian Healthcare Services is hiring a Medical Economics Analyst for Payment Integrity. This remote role supports data-driven cost savings, claims validation, and pre/post-pay initiatives.

You will work with claims data, develop rules, and translate findings into financial impact, using SQL/SAS in a large enterprise data environment. The position emphasizes analytical rigor, collaboration with finance, and delivering executive-ready insights on savings and opportunities within New Mexico

Qualifications

• Bachelor’s degree in Actuarial Science, Economics, Finance, Data Analytics, Healthcare Administration, or related field (or equivalent).
• 2–5+ years of experience in healthcare analytics, medical economics, or payment integrity.
• Strong technical skills in SQL and/or SAS; experience querying large relational databases.
• Experience working with claims data and reimbursement methodologies (fee schedules, IPPS, OPPS).
• Demonstrated ability to perform financial and statistical analysis on large datasets.
• Strong problem-solving skills with attention to detail and data accuracy.

Responsibilities

• Partner with Payment Integrity, Operations, and vendors to support pre-pay and post-pay initiatives.
• Analyze claims data to identify overpayments, billing anomalies, and coding discrepancies.
• Develop and refine rules, algorithms, and audit strategies to improve payment accuracy.
• Translate operations into measurable financial outcomes tied to TCOC.
• Validate identified savings through claims-level analysis and audit reviews.
• Quantify gross and net savings (pre-pay edits, post-pay recoveries, avoidance).
• Perform before/after and control-group analyses to ensure credibility of savings.
• Align validated savings with general ledger and financial reporting.
• Extract, transform, and analyze large healthcare datasets using SQL/SAS or similar tools.
• Build repeatable datasets and analytic pipelines in enterprise data warehouses.
• Develop dashboards and reporting tools to monitor payment integrity performance.
• Integrate external/vendor outputs into internal analytics frameworks.
• Produce executive-ready summaries highlighting drivers, risks, and actions.
• Monitor initiative performance and identify new opportunities.
• Generate pre-payment edit contribution invoices for Self-Funded accounts.

Skills

SQL

SAS

Relational DBs

Data Analytics

Education

Bachelor's degree

Actuarial Science

Economics

Finance

Data Analytics

Healthcare Administration

Job description

Presbyterian Healthcare Services is hiring a Medical Economics Analyst for Payment Integrity. This remote role supports data-driven cost savings, claims validation, and pre/post-pay initiatives.

You will work with claims data, develop rules, and translate findings into financial impact, using SQL/SAS in a large enterprise data environment. The position emphasizes analytical rigor, collaboration with finance, and delivering executive-ready insights on savings and opportunities within New Mexico