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Payment Integrity Program Manager Jobs in New Mexico

Lockheed Martin

Senior Program Manager

Albuquerque, NM · On-site

$108K - $108K/yr

This Program Manager role provides support to operational satellite ground systems, satellite ... integrity and corporate responsibility. If this sounds like a culture you connect with, you're ...

Akima, LLC

Senior Program Manager

Albuquerque, NM · On-site

$112K - $112K/yr

We are seeking a highly skilled Program Manager to lead a mission-critical IT security program ... Collaborate with security teams to ensure the integrity, availability, and confidentiality of ...

Auria

Senior Program Manager

Albuquerque, NM · On-site

$151K - $197K/yr

Experience managing contracts with milestone-based deliverables or incentive-based payment ... Access our Employee Assistance Program (EAP) for mental health, financial coaching, and more ...

KBR

Site Program Manager

Las Cruces, NM · On-site

$140K - $192K/yr

Site Program Manager B elong. Connect. Grow. with KBR! KBR's National Security Solutions team ... or discretionary payments for exceptional performance. Ready to Make a Difference? If you're ...

Intel

Materials Program Manager

Albuquerque, NM

Join us as a Materials Program Manager, where you will play an operationally focused role ... Ensuring that bills of materials integrity, materials availability, cost, and quality goals are set ...

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Payment Integrity Program Manager information

What is the difference between Payment Integrity Program Manager vs Payment Recovery Specialist?

AspectPayment Integrity Program ManagerPayment Recovery Specialist
CredentialsTypically requires a bachelor’s degree in healthcare, finance, or related fields; certifications like CPC or CPAT are commonOften requires similar healthcare or finance background; certifications like CPC or CPT may be preferred
Work EnvironmentWorks within healthcare organizations or insurance companies, focusing on program oversight and complianceOperates in claims departments or recovery units, focusing on identifying and recovering overpayments
Employer & IndustryHealthcare payers, insurance companies, government programsInsurance companies, healthcare providers, third-party recovery firms

The Payment Integrity Program Manager oversees programs to prevent improper payments, ensuring compliance and efficiency. In contrast, the Payment Recovery Specialist focuses on identifying and recovering overpaid claims. While both roles require healthcare and finance knowledge, the Program Manager has broader responsibilities related to program management, whereas the Recovery Specialist concentrates on claims recovery activities.

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Medical Economics Analyst-Payment Integrity

Medical Economics Analyst-Payment Integrity

Presbyterian Healthcare Services

Santa Fe, NM • On-site, Remote

$87K - $149K/yr

Full-time

Medical, Dental, Vision, Life

Posted 29 days ago

Presbyterian Healthcare Services rating

7.0

Company rating: 7.0 out of 10

Based on 162 frontline employees who took The Breakroom Quiz

416th of 890 rated healthcare providers

Job description

Location Address:
Remote OfficeSanta Fe, NM 87501
Compensation Pay Range:
Minimum Offer $87,526.40Maximum Offer $149,032.00Now Hiring: Medical Economics Analyst-Payment Integrity
Summary:
Build your Career. Make a Difference. Presbyterian is hiring a skilled Medical Economics Analyst-Payment Integrity to join our team.Type of Opportunity: Full timeJob Exempt: YesJob is based: Remote Workers New MexicoWork Shift: Weekday Schedule Monday-Friday (United States of America)
Responsibilities:
The Payment Integrity Medical Economics Analyst plays a critical role in identifying, quantifying, and validating medical cost savings opportunities through deep partnership with the Payment Integrity team. This role combines advanced analytics, claims validation, and financial insight to ensure accuracy of payments, integrity of savings initiatives, and alignment to total cost of care (TCOC) objectives.
This individual will leverage enterprise data assets, including claims and provider data, to produce actionable insights, validate recoveries, and support pre- and post-pay integrity initiatives. The role requires strong technical expertise (SQL/SAS), comfort working with large healthcare datasets, and the ability to translate findings into clear financial impact.
Some key responsibilities include:
  • Partner closely with Payment Integrity, Operations, and vendor partners (e.g., Cotiviti, Optum) to support pre-pay and post-pay initiatives
  • Analyze claims data to identify patterns of overpayment, billing anomalies, and coding discrepancies
  • Support development and refinement of rules, algorithms, and audit strategies to improve payment accuracy
  • Translate operational PI activities into measurable financial outcomes tied to TCOC
  • Validate identified savings opportunities through detailed claims-level analysis and audit review
  • Develop and maintain methodologies to quantify gross and net savings (pre-pay edits, post-pay recoveries, avoidance)
  • Perform before/after and control group analyses to ensure credibility of savings estimates
  • Partner with finance to align validated savings with general ledger and financial reporting
  • Extract, transform, and analyze large-scale healthcare datasets using SQL, SAS, or similar tools
  • Work within enterprise data warehouse environments to build repeatable datasets and analytic pipelines
  • Develop dashboards and reporting tools to monitor payment integrity performance and trends
  • Support integration of external/vendor outputs into internal analytics frameworks
  • Produce clear, concise reporting on payment integrity performance, savings, and emerging opportunities
  • Develop executive-ready summaries highlighting key drivers, risks, and recommended actions
  • Support ongoing monitoring of initiative performance and identification of new opportunities
  • Generate pre-payment edit contribution invoices for Self-Funded accounts

Qualifications:
  • Bachelor's degree in Actuarial Science, Economics, Finance, Data Analytics, Healthcare Administration, or related field (or equivalent experience)
  • 2-5+ years of experience in healthcare analytics, medical economics, or payment integrity
  • Strong technical skills in SQL and/or SAS (required); experience querying large relational databases
  • Experience working with claims data and reimbursement methodologies (fee schedules, IPPS, OPPS)
  • Demonstrated ability to perform financial and statistical analysis on large datasets
  • Strong problem-solving skills with attention to detail and data accuracy

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.
Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.
Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.
About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.
Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services

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About Presbyterian Healthcare Services

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Presbyterian Healthcare Services exists to improve the health of patients, members and the communities we serve. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1,600 providers and nearly 4,700 nurses.

Industry

Hospitals

Company size

10,000+ Employees

Headquarters location

Albuquerque, NM, US

Year founded

1908

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