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Director Payment Integrity Analyst Jobs (NOW HIRING)

Point32Health

Director - Payment Integrity

Canton, MA · On-site

$550/day

Oversight of day-to-day Payment Integrity $550+ million portfolio and functions. Meet or exceed ... The Sr. Director will analyze data and trends to identify opportunities for process improvements ...

Bcbsa

Director, Payment Integrity

Chicago, IL

The Director, Payment Integrity serves as BCBSA's enterprise leader for advancing a System-wide ... Strong data & analytics background with the ability to leverage data for program design and ...

Point32health

Director - Payment Integrity

Canton, MA · On-site

$550/day

Oversight of day-to-day Payment Integrity $550+ million portfolio and functions. Meet or exceed ... The Sr. Director will analyze data and trends to identify opportunities for process improvements ...

HealthOne Alliance

Payment Integrity Analyst

Dalton, GA · On-site

JOB PURPOSE A Payment Integrity Analyst reviews healthcare claims, payments, and billing to find errors, fraud, waste, or abuse, ensuring compliance with rules (like CMS) and policies, using strong ...

HealthOne Alliance

Payment Integrity Analyst

Dalton, GA · On-site

JOB PURPOSE A Payment Integrity Analyst reviews healthcare claims, payments, and billing to find errors, fraud, waste, or abuse, ensuring compliance with rules (like CMS) and policies, using strong ...

Devoted Health

Director, Payment Integrity

Nottingham, MD · On-site +1

$182K - $217K/yr

The Director of Payment Integrity will be a subject matter expert (SME) for clinical, coding, and technical payment accuracy. This role is designed for a credentialed expert who can bridge the gap ...

Lyric

Payment Integrity Analyst - Data Mining

JOB SUMMARY The Payment Integrity Analyst (Data Mining) supports the Data Mining (DM) program by investigating payment errors due to incorrect processing of payment policies, contract terms, billing ...

Corvel

Payment Integrity Analyst II

Fort Worth, TX · On-site

$66K - $101K/yr

The Payment Integrity Analyst is responsible for accurately reviewing and completing pre- and post pay claim audits based on client, policy, industry standards and/or CMS guidelines. This is a remote ...

CERiS

Payment Integrity Analyst II

Fort Worth, TX · Remote

$66K - $101K/yr

The Payment Integrity Analyst is responsible for accurately reviewing and completing pre- and post pay claim audits based on client, policy, industry standards and/or CMS guidelines. ESSENTIAL ...

Corvel

Payment Integrity Analyst II

Fort Worth, TX · On-site

$66K - $101K/yr

The Payment Integrity Analyst is responsible for accurately reviewing and completing pre- and post pay claim audits based on client, policy, industry standards and/or CMS guidelines. ESSENTIAL ...

Corvel

Payment Integrity Analyst II

Fort Worth, TX · Remote

$66K - $101K/yr

The Payment Integrity Analyst is responsible for accurately reviewing and completing pre- and post pay claim audits based on client, policy, industry standards and/or CMS guidelines. ESSENTIAL ...

Corvel

Payment Integrity Analyst II

Fort Worth, TX · Remote

$66K - $101K/yr

The Payment Integrity Analyst is responsible for accurately reviewing and completing pre- and post pay claim audits based on client, policy, industry standards and/or CMS guidelines. This is a remote ...

CERiS

Payment Integrity Analyst II

Fort Worth, TX · On-site

$66K - $101K/yr

The Payment Integrity Analyst is responsible for accurately reviewing and completing pre- and post pay claim audits based on client, policy, industry standards and/or CMS guidelines. ESSENTIAL ...

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Director Payment Integrity Analyst information

What is the difference between Director Payment Integrity Analyst vs Payment Integrity Analyst?

AspectDirector Payment Integrity AnalystPayment Integrity Analyst
CredentialsBachelor's degree, certifications like CPC or CPHQ often preferredBachelor's degree, similar certifications often required
Work EnvironmentLeadership role overseeing teams, strategic planningOperational role focusing on data analysis and claims review
Employer & IndustryHealthcare payers, insurance companies, government agenciesHealthcare payers, insurance companies, healthcare providers

The main difference is that the Director Payment Integrity Analyst typically holds a leadership position with strategic responsibilities, while the Payment Integrity Analyst focuses on data analysis and claims review tasks. Both roles require similar credentials and are found in similar environments, but the director role involves overseeing teams and developing policies.

How does a Director Payment Integrity Analyst collaborate with other departments to ensure accurate claims processing?

A Director Payment Integrity Analyst works closely with teams such as claims processing, compliance, finance, and IT to identify and resolve payment inaccuracies. They lead cross-functional initiatives to analyze claim trends, design audit strategies, and implement corrective actions. Regular collaboration ensures that policies are consistently applied, errors are minimized, and regulatory requirements are met. This role often involves facilitating meetings, sharing insights, and training staff on new processes to maintain high standards of payment integrity across the organization.

What is a Director Payment Integrity Analyst?

A Director Payment Integrity Analyst is a senior-level professional who oversees the processes and teams responsible for ensuring accurate payments in healthcare or insurance organizations. Their role includes identifying and preventing improper payments, managing audits, analyzing claims data for errors or fraud, and implementing strategies to improve payment accuracy. They also collaborate with other departments to ensure compliance with regulations and promote cost savings for the organization. This position requires strong analytical, leadership, and industry-specific knowledge.

What are the key skills and qualifications needed to thrive as a Director Payment Integrity Analyst, and why are they important?

To thrive as a Director Payment Integrity Analyst, you need strong analytical skills, expertise in healthcare claims, and a background in finance or a related field—often supported by a bachelor's or master's degree. Familiarity with data analytics tools (like SQL or SAS), healthcare claims platforms, and certifications such as Certified Professional Coder (CPC) are commonly required. Exceptional leadership, strategic thinking, and communication abilities help drive team performance and stakeholder collaboration. These skills ensure accurate claim processing, minimize financial losses, and support organizational compliance within complex healthcare environments.
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Infographic showing various Director Payment Integrity Analyst job openings in the United States as of June 2026, with employment types broken down into 83% Full Time, 15% Part Time, and 2% Contract. Highlights an 81% Physical, 8% Hybrid, and 11% Remote job distribution.
Director - Payment Integrity

Director - Payment Integrity

Point32Health

Canton, MA • On-site

$550/day

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 4 days ago

Job description

Who We Are
Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We've had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it's at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.
We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health.
Job Summary
Reporting to the Vice President of Payment Integrity, the Director, Payment Integrity will lead the development and execution of strategies to optimize payment accuracy and expand the organization's audit capabilities. The Director will be responsible for daily oversight of key functions including Payment Policy, Edit configuration and maintenance, management of multiple internal teams and external vendor audit functions, oversight of vendor arrangements including contract amendments and SLAs, management of Base Fee Schedules. The Sr. Director is also responsible for developing Payment Integrity Strategy, implementation and management of all functions.
Job Description
Key Responsibilities/Duties - what you will be doing (top five)
  • Oversight of day-to-day Payment Integrity $550+ million portfolio and functions. Meet or exceed annual savings targets established by leadership through Total Cost of Care efforts which are typically 8-10% incremental goals year over year. Responsible to develop new programs and continually improve existing programs while evaluating the most efficient and cost-effective way to manage recovery work and achieve goals.
  • Strategic Planning: Continually review Payment Integrity vendor relationships, internal staffing, infrastructure and tools and develop short and long term plans that link to a comprehensive approach to Policy, edit and audit work necessary to achieve established corporate goals, enhance operational efficiencies and ensure that accuracy of claim payment.
  • Performance Monitoring and Analysis: Develop and implement metrics and key performance indicators (KPIs) to monitor Payment Integrity performance, including vendor management of contractual SLAs and/or expected adherence to workflows, QC and submission guidelines, decisions around vendor pass positions, ability to achieve expected savings targets and management of accurate reporting. The Sr. Director will analyze data and trends to identify opportunities for process improvements and new savings opportunities and ensure that we remain competitive relative to other payors in our service area.
  • Compliance and Regulatory Compliance: Ensure compliance with all relevant regulatory requirements, accreditation standards, and contractual obligations related to edit and audit functions. Stay informed and react quickly to changes in healthcare regulations and industry trends that may impact provider contracting and reimbursement practices.
  • Strategic Partnerships: Collaborate with internal department leadership as needed to understand and react appropriately to provider concerns to assist with the corporate provider experience initiatives
  • Other projects and duties as assigned.

Qualifications - what you need to perform the job
Education
  • Required (minimum): Bachelor's degree in Healthcare Administration, Business Administration, or a related field
  • Preferred: Master's degree

Experience
  • Required: (minimum) 5 years leadership/management experience required in related Payment Integrity/Audit functions.
  • Experience managing external audit vendors and/or internal audit teams
  • Operational experience with pricing software, edit vendors and software and Policy development
  • Exhibit leadership capabilities and demonstrated ability to effectively work with all levels and cross-functionally within the company.
  • Experience managing in a fast paced, high volume, transaction-driven environment necessary.
  • General knowledge of health insurance products.
  • Health insurance claim management experience preferred for a period of at least three-five (3-5) years.
  • Knowledge of Medicare and Medicaid Regulations is preferred.
  • Strong subject matter expertise and knowledge of all relevant laws, contractual requirements, industry standards and best practices required.

Skill Requirements
  • Strong understanding of healthcare delivery systems, provider reimbursement methodologies, and regulatory requirements.
  • Excellent communication, negotiation, and relationship and team building skills, with the ability to collaborate effectively with internal and external stakeholders.
  • Strategic thinking and analytical skills, with the ability to develop and execute complex provider network strategies.
  • Knowledge of healthcare IT systems and tools, including provider databases, claim processing systems, and network analytics platforms.

Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel):
  • Must be able to work under normal office conditions and work from home as required.
  • Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
  • May be required to work additional hours beyond standard work schedule.

The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.
Salary Range
$160,335.20 -$240,502.80
Compensation & Total Rewards Overview
The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization. The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; as well as internal equity. As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company's sole discretion, consistent with the law.
Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:
  • Medical, dental and vision coverage
  • Retirement plans
  • Paid time off
  • Employer-paid life and disability insurance with additional buy-up coverage options
  • Tuition program
  • Well-being benefits
  • Full suite of benefits to support career development, individual & family health, and financial health

For more details on our total rewards programs, visit https://www.point32health.org/careers/benefits/
We welcome all
All applicants are welcome and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
Scam Alert: Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact TA_operations@point32health.org

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