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Director Payment Integrity Analyst Jobs (NOW HIRING)

Cotiviti

Overview The Sr. Director of Payment Policy Management (PPM) Operations is responsible for ... Highly developed interpersonal, analytical, and communication abilities. * Proven record of ...

Cotiviti

Director Quality (Payment Integrity)

... The Director of Quality is responsible for ensuring quality delivery of the Payment Integrity ... Highly developed interpersonal, analytical, and communication skills. * Proven track record of ...

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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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Director Payment Integrity Analyst jobs near you
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.
Analyst, Payment Integrity

Analyst, Payment Integrity

Hawaii Medical Service Association

Honolulu, HI • Hybrid

Full-time

Posted 6 days ago

Job description

  1. Research and Analysis
    • Serve as contact for external vendors and internal departments to support operations and payment integrity activities.
    • Research and respond to low to high priority complex internal and external inquiries.
    • Analyze and coordinate vendor performance reviews using KPIs (e.g., recovery yield, turnaround time, false positive rates, provider abrasion).
    • Coordinate reconciliation of vendor invoices, validating against contractual terms, recoveries, and performance metrics.
    • Is proficient at utilizing a variety of resources including but not limited to on-line information files and databases, Medicare/other plan guidelines, plan certificates, provider contracts.
    • Update and create CES and Cotiviti pend resolutions.
  2. Business Analysis & Reporting
    • Analyze operational and financial data to identify trends, savings opportunities, and anomalies.
    • Assess business impact of new edits and changes in medical reimbursement policies/guidelines.
    • Initiate, develop, coordinate and implement cost/benefit analysis of claims processing.
    • Develop documentation, including cost/benefit and business impact analysis and recommendations to implement and/or improve claims processing.
    • Collaborate with IT and data teams to validate extracts, reconciliations, and vendor reporting feeds.
  3. Operational & Strategic Alignment
    • Recommend process improvements to increase efficiency and results.
    • Identification and resolution of issues and trends as a result of researching and responding to implementation requests, problem reports, and inquiries.
    • Support cross-functional projects, including audit response, regulatory requests, and enterprise cost-containment strategies.
    • Act as SME (subject matter expert) on payment integrity activities, workflow design, and best practices.
  4. Performs all other miscellaneous responsibilities and duties as assigned or directed.
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