Remote Medical Economics Analyst - Payment Integrity

Presbyterian Healthcare Services; United States; A distancia; USD 88.000 - 149.000; Jornada completa

Descripción de la vacante

Presbyterian Healthcare Services is seeking a Medical Economics Analyst-Payment Integrity to join our remote team in New Mexico. This full-time role requires SQL/SAS expertise and in-depth analysis of claims data to identify overpayments and savings opportunities, aligning with TCOC goals.

You will partner with vendors and internal teams to drive pre-pay and post-pay initiatives while delivering executive-ready insights.

Formación

• Bachelor’s degree in Actuarial Science, Economics, Finance, Data Analytics, Healthcare Administration, or related field (or equivalent experience)
• 2–5+ years of experience in healthcare analytics, medical economics, or payment integrity
• Strong technical skills in SQL and/or SAS (required); 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

Responsabilidades

• Partner with Payment Integrity, Operations, and vendor partners (e.g., Cotiviti, Optum) to support pre-pay and post-pay initiatives
• Analyze claims data to identify patterns of overpayment, billing anomalies, and coding discrepancies
• Develop and refine rules, algorithms, and audit strategies to improve payment accuracy
• Translate operational PI activities into measurable financial outcomes tied to TCOC
• Validate identified savings opportunities through detailed claims-level analysis and audit review
• Develop and maintain methodologies to quantify gross and net savings (pre-pay edits, post-pay recoveries, avoidance)
• Perform before/after and control group analyses to ensure credibility of savings estimates
• Partner with finance to align validated savings with general ledger and financial reporting
• Extract, transform, and analyze large-scale healthcare datasets using SQL, SAS, or similar tools
• Work within enterprise data warehouse environments to build repeatable datasets and analytic pipelines
• Develop dashboards and reporting tools to monitor payment integrity performance and trends
• Support integration of external/vendor outputs into internal analytics frameworks
• Produce clear, concise reporting on payment integrity performance, savings, and emerging opportunities
• Develop executive-ready summaries highlighting key drivers, risks, and recommended actions
• Support ongoing monitoring of initiative performance and identification of new opportunities
• Generate pre-payment edit contribution invoices for Self-Funded accounts

Conocimientos

Healthcare analytics

Financial analysis

Data querying large datasets

Educación

Bachelor’s degree in related field

Herramientas

SQL

SAS

Descripción del empleo

Presbyterian Healthcare Services is seeking a Medical Economics Analyst-Payment Integrity to join our remote team in New Mexico. This full-time role requires SQL/SAS expertise and in-depth analysis of claims data to identify overpayments and savings opportunities, aligning with TCOC goals.

You will partner with vendors and internal teams to drive pre-pay and post-pay initiatives while delivering executive-ready insights.