Senior Payment Integrity Analytics Lead (Remote)

Inland-Empire-Health-Plan-; Rancho Cucamonga (CA); On-site; USD 91,000 - 121,000; Full time

Benefits offered by this job

Competitive salary

On-site fitness center

Medical, dental, vision insurance

Life and disability insurance

Career advancement opportunities

Wellness programs

Flexible Spending Account

457(b) retirement plan

Pet care insurance

Job summary

IEHP in Rancho Cucamonga is seeking a Senior Payment Integrity Analyst to lead daily PI operations, audits, and reporting. The role includes mentoring junior analysts and driving cost containment and regulatory compliance, with a focus on payment integrity and provider claims accuracy.

Responsibilities include data mining with SQL/Excel, dashboard development, and collaboration with providers to resolve payment discrepancies. Strong experience in CMS/DHCS and auditing is required.

Qualifications

• Five years of experience in payment integrity, claims auditing, and/or medical coding
• Strong data analysis and query experience
• Experience with contract interpretation (DOFR) and CMS/HIPAA regulations
• Bachelor’s degree required or four additional years of relevant work experience in lieu of degree

Responsibilities

• Lead audit and investigation to improve claim payment accuracy and financial performance
• Develop and refine audit data mining techniques and dashboards to detect irregularities
• Collaborate with providers to resolve payment discrepancies and defend reimbursement decisions
• Oversee complex CMS/DHCS regulatory interpretation for PI audits and system edits
• Mentor junior analysts and ensure QC of work
• Oversee vendor audit pipelines and ensure regulatory compliance

Skills

Data analysis

SQL

Excel

Data visualization

Education

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

Job description

IEHP in Rancho Cucamonga is seeking a Senior Payment Integrity Analyst to lead daily PI operations, audits, and reporting. The role includes mentoring junior analysts and driving cost containment and regulatory compliance, with a focus on payment integrity and provider claims accuracy.

Responsibilities include data mining with SQL/Excel, dashboard development, and collaboration with providers to resolve payment discrepancies. Strong experience in CMS/DHCS and auditing is required.