[Hiring] Payment Integrity Analyst @MVP Health Care

Role Description

This role will support accurate, compliant healthcare reimbursement across our health plan. You’ll perform in‑depth coding reviews, interpret payer and regulatory policy, and contribute to claims editing logic that improves payment accuracy and reduces inappropriate spend.

Qualifications

• Bachelor’s degree in healthcare administration, business, or related field preferred; equivalent experience accepted
• Active medical coding certification (CPC, CCS, COC, or equivalent)
• 3+ years of experience working as a certified medical coder
• 4+ years of experience in healthcare coding, billing, or payment accuracy
• Experience with claims processing workflows (CMS-1500, UB-04) and claims editing software
• Familiarity with CMS policies, CCI edits, OIG alerts, and fee schedules

Requirements

• Strong working knowledge of CPT/HCPCS & ICD10 coding, Correct Coding Initiatives, and claims billing
• Analytical mindset with ability to synthesize data into actionable insights
• Excellent written and verbal communication skills
• Intermediate Excel skills (pivot tables, VLOOKUP, functions); SQL skills a plus
• Ability to manage competing priorities and operate in a fast-paced environment
• Curiosity to foster innovation and pave the way for growth
• Humility to play as a team
• Commitment to being the difference for our customers in every interaction

Key Responsibilities

• Review professional and facility provider claims to ensure coding accuracy and compliant reimbursement
• Apply ICD‑10, CPT, HCPCS, DRGs, modifiers, POA indicators, and revenue codes appropriately
• Interpret and translate CMS, AMA/CPT, and commercial payer policy into actionable claims editing logic
• Partner with engineering and product teams to develop and maintain claims edit specifications
• Analyze claims data to identify trends, discrepancies, and payment process improvement opportunities
• Support customer appeals, audits, and policy reviews by assessing appropriateness of billed services
• Collaborate cross‑functionally to improve tooling, workflows, and content delivery
• Train and advise internal teams and clients on payment integrity best practices and regulatory considerations
• Ensure all reviews and analyses comply with regulatory guidelines and organizational policies
• Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer

Pay Transparency

MVP Health Care is committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role.

We do not request current or historical salary information from candidates.

$69,383.00-$92,279.00

MVP's Inclusion Statement

At MVP Health Care, we believe creating healthier communities begins with nurturing a healthy workplace. As an organization, we strive to create space for individuals from diverse backgrounds and all walks of life to have a voice and thrive. Our shared curiosity and connectedness make us stronger, and our unique perspectives are catalysts for creativity and collaboration.

MVP is an equal opportunity employer and recruits, employs, trains, compensates, and promotes without discrimination based on race, color, creed, national origin, citizenship, ethnicity, ancestry, sex, gender identity, gender expression, religion, age, marital status, personal appearance, sexual orientation, family responsibilities, familial status, physical or mental disability, handicapping condition, medical condition, pregnancy status, predisposing genetic characteristics or information, domestic violence victim status, political affiliation, military or veteran status, Vietnam-era or special disabled Veteran or other legally protected classifications.

To support a safe, drug-free workplace, pre-employment criminal background checks and drug testing are part of our hiring process. If you require accommodations during the application process due to a disability, please contact our Talent team at [email protected].