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Payment Integrity Auditor Jobs (NOW HIRING)

Centene

RN Readmission Manager, Payment Integrity

OR · On-site +1

  • Medical

  • Retirement

  • PTO

... experience in Payment Integrity, including readmission review and DRG validation activities ... Manages a team of auditors and clinical professionals and is accountable for audit quality ...

Corvel

Payment Integrity Analyst III - Trainer

Fort Worth, TX · On-site

$73K - $113K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Medical bill auditing * Experience in the acute clinical areas of facilities in O.R., I.C.U., C.C.U ... payment integrity experience * 3+ years of relevant experience or equivalent combination of ...

Corvel

Payment Integrity Analyst III - Trainer

Fort Worth, TX · Remote

$73K - $113K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Medical bill auditing * Experience in the acute clinical areas of facilities in O.R., I.C.U., C.C.U ... payment integrity experience * 3+ years of relevant experience or equivalent combination of ...

Corvel

Payment Integrity Analyst II

Fort Worth, TX · Remote

$66K - $101K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

The Payment Integrity Analyst is responsible for accurately reviewing and completing pre- and post ... Medical bill auditing * Experience in the acute clinical areas of facilities in O.R., I.C.U., C.C.U ...

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Payment Integrity Auditor information

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How much do payment integrity auditor jobs pay per year?

As of Aug 16, 2026, the average yearly pay for payment integrity auditor in the United States is $92,797.00, according to ZipRecruiter salary data. Most workers in this role earn between $72,000.00 and $112,000.00 per year, depending on experience, location, and employer.

What are some common challenges payment integrity auditors face when reviewing healthcare claims?

Payment Integrity Auditors often encounter challenges such as identifying complex billing errors, staying current with frequently changing healthcare regulations, and navigating large volumes of claims data. They must also collaborate with various departments, like clinical teams and compliance, to verify the accuracy of claims and resolve discrepancies. Strong analytical skills and attention to detail are crucial for success in this dynamic and fast-paced environment.

What are the key skills and qualifications needed to thrive as a payment integrity auditor?

To thrive as a Payment Integrity Auditor, you need strong analytical skills, attention to detail, and a solid understanding of healthcare claims, typically supported by a degree in finance, healthcare administration, or a related field. Familiarity with claims processing systems, data analysis tools like Excel or SQL, and knowledge of relevant regulations such as HIPAA are often required. Effective communication, investigative mindset, and problem-solving abilities are essential soft skills for identifying discrepancies and collaborating with cross-functional teams. These skills are crucial for ensuring accurate payments, detecting fraud, and maintaining compliance within healthcare organizations.

What is the difference between Payment Integrity Auditor vs Claims Analyst?

AspectPayment Integrity AuditorClaims Analyst
Required CredentialsCertification in auditing or healthcare compliance often preferredRelevant degrees in healthcare, finance, or related fields; certifications vary
Work EnvironmentHealthcare organizations, insurance companies, government agenciesInsurance companies, healthcare providers, third-party administrators
Employer & Industry UsageFocuses on verifying payment accuracy and fraud detectionAnalyzes claims data to determine validity and processing issues

Payment Integrity Auditors primarily focus on verifying the accuracy of payments and detecting fraud, while Claims Analysts review and process claims data to ensure proper reimbursement. Both roles require knowledge of healthcare billing and compliance, but Payment Integrity Auditors emphasize auditing and fraud prevention, whereas Claims Analysts focus on claims processing and analysis.

What is a payment integrity auditor?

Payment Integrity Auditors are professionals who review healthcare claims and financial transactions to ensure payments are accurate and compliant with regulations. They identify overpayments, underpayments, and fraudulent activities by analyzing billing data, medical records, and policy guidelines. Their work helps healthcare organizations minimize financial losses, improve operational efficiency, and maintain compliance with government and industry standards.
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What states have the most Payment Integrity Auditor jobs?

States with the most job openings for Payment Integrity Auditor jobs include:

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Payment Integrity Auditor jobs near you
Infographic showing various Payment Integrity Auditor job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 15% Part Time, and 2% Contract. Highlights an 94% Physical, 2% Hybrid, and 4% Remote job distribution, with an average salary of $92,797 per year, or $44.6 per hour.

Clinical Manager- Payment Integrity

SmartLight Analytics

Plano, TX • On-site, Remote

Full-time

Posted 16 days ago

Job description

Position Overview:
The Manager of Payment Integrity serves as the bridge between clinical expertise and business operations. This role evaluates payment integrity processes as it relates to carrier reimbursements, supports operational decision-making, ensures quality and compliance, and partners with internal and external stakeholders to improve outcomes, efficiency, and experience. The Manager of Payment Integrity uses clinical knowledge, data insights, and process thinking to guide program strategy, resolve escalations, and support continuous improvement across the organization. Additionally, this role leads, manages and mentors the department's Clinical Analysts.
Responsibilities
  • Review medical records for billing accuracy and coding guidelines
  • Have experience reviewing both facility and provider claims
  • Understand and apply NCCI guidelines and be able to recognize common claims errors
  • Review clinical documentation, guidelines, and cases to ensure accuracy, compliance, and alignment with standards
  • Provide data analytics to support client and carrier requests
  • Partner with internal teams to improve accuracy using data analysis and carrier feedback
  • Provide clinical expertise to support operational workflows including reviewing claims data medical records
  • Partner with cross-functional teams to design and refine clinical processes that improve outcomes and efficiency
  • Monitor clinical quality metrics and identify trends, gaps, and opportunities for improvement
  • Prepare carrier responses on open and active referrals
  • Lead carrier calls, referral calls with carrier network and clients
  • Maintain accurate records of clinical policies, workflows, and quality initiatives
  • Lead, manage and mentor the department's Clinical Analyst(s)
  • Collaborate with IT and serve as the liaison on business and reporting requirements for departmental IT initiatives
  • Translate clinical insights into operational recommendations that improve performance, cost efficiency, and service quality
  • Collaborate with Operations, Payment Integrity, and other teams to resolve escalations
  • Support the development of SOPs, training materials, and process improvements
  • Analyze clinical and operational data to identify patterns, risks, and opportunities
  • Develop and maintain dashboards, reports, and performance summaries for leadership
  • Serve as a clinical subject-matter expert for internal teams, carriers, partners, and vendors
  • Provide clear, empathetic communication to support escalations, case reviews, and program updates
  • Participate in cross-functional meetings, business reviews, and strategic planning sessions
  • Develop and deliver training for internal teams on clinical guidelines, workflows, and quality expectations
  • Support onboarding of new team members by providing clinical context and program knowledge
  • Ensure teams understand clinical requirements that impact operations, payments, or partner experience
  • Develop data visualizations with Excel or data visualization tools

Qualifications
  • Active clinical license (RN, LPN/LVN or other relevant credential) preferred or inactive license with relative clinical experience or relative clinical data experience
  • Bachelor's degree in Nursing, Healthcare Administration, Business, or related field; advanced degree a plus
  • At least one of the following certifications: CPC, CCS, or similar clinical/coding credential
  • 5+ years in TPA/Carrier claims processing or payment integrity related areas
  • 5+ years years of experience in healthcare administration, billing, claims processing, clinical auditing, payment integrity, or related areas
  • Working knowledge of medical claims data, medical procedures, and healthcare workflows
  • Strong attention to detail and ability to communicate clearly in writing and verbally
  • Experience working with commercial health plans is a plus
  • Solid analytical and critical-thinking skills
  • Preferred- experience reviewing medical records and/or claims data from a payor perspective (preferably in a medical insurance carrier setting)
  • Experience working in a cross-functional business environment strongly preferred
  • Experience as a people leader/managing a team

Skills & Competencies
  • Strong clinical judgment with the ability to apply guidelines and standards consistently
  • Analytical mindset with experience interpreting clinical and operational data
  • Excellent communication and relationship-building skills
  • Strong organizational and project-management abilities
  • Ability to navigate complex issues with professionalism, empathy, and accountability
  • Proficiency with EMR systems, clinical documentation tools, or workflow platforms is a plus

Success Indicators
  • High accuracy and consistency in clinical reviews and documentation
  • Improved quality metrics and reduced clinical-related escalations
  • Strong cross-functional alignment between clinical and business teams
  • Clear, effective communication that supports partners and internal stakeholders
  • Scalable clinical processes that support operational growth and efficiency

Who is SmartLight Analytics
SmartLight Analytics was formed by a group of industry insiders who wanted to make a meaningful impact on the rising cost of healthcare. With this end in mind, SmartLight works for self-funded employers to reduce wasteful spending in their healthcare plan through our proprietary data analysis. Our process works behind the scenes to save money without interrupting employee benefits or requiring employee behavior changes.

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