Senior Payment Integrity & Analytics Lead

IEHP; Rancho Cucamonga (CA); On-site; USD 80,000 - 106,000; Full time

Benefits offered by this job

Competitive salary

State of the art fitness center on‑sit

Medical Insurance with Dental and Vis

Life, short-term, and long-term disab

Career advancement opportunities and p

Wellness programs that promote a healt

Flexible Spending Account – Health C"

CalPERS retirement

457(b) option with a contribution map

Paid life insurance for employees

Pet care insurance

Job summary

IEHP is seeking a Senior Payment Integrity Program Development Specialist in Rancho Cucamonga, CA to lead research and development of payment integrity initiatives. The role focuses on strengthening payment accuracy, reducing overpayments, and ensuring regulatory compliance through data-driven concept logic and vendor collaboration.

Responsibilities include evaluating cost trends, partner collaboration with Clinical, Policy, and SIU, and driving cost avoidance improvements across Payment

Qualifications

• Minimum 5 years of relevant experience in payment integrity or healthcare analytics.
• Experience creating concept logic, tracking performance, and working with external vendors.
• Experience with SQL or data mining; complex claims analytics and trend evaluation.
• Bachelor’s degree in business, health administration, or related field.
• In lieu of degree, 4 additional years of relevant work experience.
• RHIA, RHIT, CCS, CPC, CIC or similar certification preferred.

Responsibilities

• Drive research, analysis, and development of Payment Integrity initiatives.
• Evaluate medical cost trends, claims patterns, and industry developments to create audit concepts.
• Partner with Clinical, Policy, and the SIU to transform findings into actionable outcomes.
• Assess and enhance pre/post payment audit programs to improve FWA detection.

Skills

SQL

Microsoft Excel

Data analysis

Communication skills

Education

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

RHIA, RHIT, CCS, CPC, CIC or similar certification preferred

Job description

IEHP is seeking a Senior Payment Integrity Program Development Specialist in Rancho Cucamonga, CA to lead research and development of payment integrity initiatives. The role focuses on strengthening payment accuracy, reducing overpayments, and ensuring regulatory compliance through data-driven concept logic and vendor collaboration.

Responsibilities include evaluating cost trends, partner collaboration with Clinical, Policy, and SIU, and driving cost avoidance improvements across Payment