[Hiring] Payment Integrity Analyst @Signature Performance, Inc.

Role Description

You are a person who loves to identify discrepancies, prevent overpayments, and ensure adherence to regulatory, contractual, and coding guidelines. We need someone who has expertise in medical coding, reimbursement methodologies, and healthcare policy and can apply that expertise to develop, implement, and maintain claims editing rules and audit processes. In the role of Payment Integrity Analyst, you will be responsible for ensuring the accuracy and compliance of healthcare claim payments across commercial, Medicare, and Medicaid lines of business.

• Lead complex claim audits and investigations involving high-risk or high-value claims
• Design, develop, and maintain advanced claims editing rules and logic
• Translate complex regulatory and reimbursement policies into system specifications
• Oversee testing, validation, and implementation of editing rules
• Conduct root cause analysis and recommend systemic solutions
• Monitor CMS, OIG, and regulatory updates; ensure organizational compliance
• Act as SME for coding, billing, and payment integrity methodologies
• Mentor junior analysts and provide technical guidance
• Collaborate with IT, policy, and leadership teams on strategic initiatives
• Support benefit configuration and optimization in platforms like TriZetto Facets
• Present findings, insights, and recommendations to leadership

Qualifications

• Associate's or Bachelor's degree in Health Administration, Public Health, Business, or related field (or equivalent experience)
• 5+ years of experience in healthcare claims, payment integrity, auditing, or revenue cycle
• Advanced expertise in coding systems, reimbursement methodologies, and CMS regulations
• Strong experience with claims editing platforms (e.g., Optum CES)
• Advanced SQL and data analysis skills
• Demonstrated experience in rule development and system configuration
• Experience with Tricare and Veterans Administration, Medicare, Medicaid, and/or commercial reimbursement methodologies
• Hands-on experience with claims adjudication and editing systems
• Strong knowledge of CPT, HCPCS, ICD-10 coding systems
• Proficiency in SQL and data analysis
• Proficiency in Excel (pivot tables, VLOOKUP, data manipulation)
• Experience with EDI transactions, CMS-1500, and claims workflows
• One or more of the following: CPC (Certified Professional Coder), CCS / CCS-P (Certified Coding Specialist), RHIT / RHIA
• Strategic thinking
• Leadership and mentorship
• Advanced analytical and technical skills
• Deep regulatory and policy expertise
• Strong decision-making and problem-solving ability

Requirements

• U.S. Citizenship or naturalized citizenship is required for this position.
• All work on all positions at Signature Performance must be completed in the continental United States, Alaska, or Hawaii.

Benefits

• Health Insurance
• Fully Paid Life Insurance
• Fully Paid Short- & Long-Term Disability
• Paid Vacation
• Paid Sick Leave
• Paid Holidays
• Professional Development and Tuition Assistance Program
• 401(k) Program with Employer Match