Senior Payment Integrity Analyst – Lead Data-Driven Claims

Inland Empire Health Plans; Rancho Cucamonga (CA); On-site; USD 105,000 - 135,000; Full time

Benefits offered by this job

Competitive salary

On-site fitness center

Medical Insurance with Dental and Vis​

Life, short-term, and long-term disa​b

Career advancement opportunities and专业

Wellness programs

Flexible Spending Account – HealthCare

CalPERS retirement

457(b) plan with match

Paid life insurance

Pet care insurance

Job summary

Inland Empire Health Plans (IEHP) is seeking a Senior Payment Integrity Analyst to lead a team of analysts and oversee daily operations of payment integrity initiatives. You will ensure accuracy of provider claims and drive cost avoidance through remediation plans.

Reporting to the Manager, Payment Integrity Operations, you will deliver daily and monthly reports, support quality assurance, and collaborate with IT and vendors to improve financial performance while maintaining regulatory

Qualifications

• Minimum of five (5) years in payment integrity, claims auditing, and/or medical coding.
• Strong data analysis and queries experience.
• Experience with contract interpretation and Division of Financial Responsibility (DOFR).
• Bachelor’s degree in business, health administration, or a related field from an accredited institution.
• Certification in RHIA, RHIT, CCS, CPC, CIC or similar certification preferred.

Responsibilities

• Lead a team of Payment Integrity Analysts on daily operations of vendor activities and internal programs.
• Provide quality assurance of junior analysts’ work and remediation plans to drive cost avoidance.
• Lead reporting of vendor activity with daily and monthly management reports to drive financial performance.
• Collaborate with leaders and IT/vendors to ensure regulatory compliance and provider claims accuracy.

Skills

Data analysis

SQL

MS Excel

Education

Bachelor's degree in business, health administration, or related field

Job description

Inland Empire Health Plans (IEHP) is seeking a Senior Payment Integrity Analyst to lead a team of analysts and oversee daily operations of payment integrity initiatives. You will ensure accuracy of provider claims and drive cost avoidance through remediation plans.

Reporting to the Manager, Payment Integrity Operations, you will deliver daily and monthly reports, support quality assurance, and collaborate with IT and vendors to improve financial performance while maintaining regulatory