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Remote Payment Integrity Analyst Jobs in Kentucky

Sagility

$20/hr

... payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees ... This is a seasonal, fully remote opportunity. Schedules, pay rates, program details, and assignment ...

Sagility LLC

$20/hr

... payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees ... This is a seasonal, fully remote opportunity. Schedules, pay rates, program details, and assignment ...

Sagility LLC

$20/hr

... payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees ... This is a seasonal, fully remote opportunity. Schedules, pay rates, program details, and assignment ...

Sagility

$20/hr

... payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees ... This is a seasonal, fully remote opportunity. Schedules, pay rates, program details, and assignment ...

Turner & Townsend

Project Manager

Shelbyville, KY · Remote

This is a remote position with some travel. What you'll do Manage all areas of project management ... Ensure project data integrity and documentation is accurate, timely, and coordinated. Build action ...

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Remote Payment Integrity Analyst information

What is a remote payment integrity analyst?

A Remote Payment Integrity Analyst is a professional who works from a remote location to review healthcare or insurance claims for accuracy, compliance, and potential fraud. Their primary role is to ensure that payments made by insurance companies or healthcare providers are correct and align with policy guidelines. They use data analysis, auditing processes, and investigative techniques to identify improper payments or billing errors. This helps organizations recover overpayments, prevent financial losses, and maintain regulatory compliance. Remote Payment Integrity Analysts typically work for health insurers, government agencies, or third-party vendors.

How does a remote payment integrity analyst typically collaborate with other departments to resolve payment discrepancies?

As a Remote Payment Integrity Analyst, you'll regularly work with teams such as billing, claims, and provider relations to investigate and resolve payment discrepancies. Clear communication—often via email, virtual meetings, or internal platforms—is crucial for gathering documentation, clarifying complex cases, and ensuring timely resolution. Collaboration may also involve sharing findings or trends to help improve overall payment processes and prevent future errors. This cross-functional teamwork is essential for maintaining accuracy and compliance in healthcare or insurance payment systems.

What are the key skills and qualifications needed to thrive as a remote payment integrity analyst, and why are they important?

To excel as a Remote Payment Integrity Analyst, you need strong analytical skills, experience in healthcare claims or payment analysis, and a bachelor’s degree in a related field. Familiarity with data analysis tools (such as Excel, SQL, or claims processing systems) and knowledge of industry regulations like HIPAA are typically required. Attention to detail, problem-solving abilities, and effective communication are vital soft skills for investigating discrepancies and collaborating with stakeholders. These competencies ensure the accurate identification of improper payments, cost savings, and compliance within healthcare organizations.

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

AspectRemote Payment Integrity AnalystRemote Claims Auditor
Required CredentialsCertifications in healthcare compliance, coding, or auditingCertifications in claims processing, auditing, or healthcare reimbursement
Work EnvironmentRemote, healthcare or insurance companiesRemote, insurance or healthcare organizations
Industry UsageHealthcare payers, insurance companiesInsurance companies, third-party administrators
Common Search IntentUnderstanding roles in payment integrity and fraud preventionAuditing claims for accuracy and compliance

The Remote Payment Integrity Analyst focuses on detecting and preventing improper payments, fraud, and abuse within healthcare claims, often requiring compliance and coding certifications. In contrast, the Remote Claims Auditor reviews claims for accuracy and adherence to policies, typically with auditing certifications. Both roles are remote, industry-specific, and involve analyzing healthcare or insurance claims, but they emphasize different aspects of claims management and compliance.

What are popular job titles related to Remote Payment Integrity Analyst jobs in Kentucky?

For Remote Payment Integrity Analyst jobs in Kentucky, the most frequently searched job titles are:

What job categories do people searching Remote Payment Integrity Analyst jobs in Kentucky look for?

The top searched job categories for Remote Payment Integrity Analyst jobs in Kentucky are:

What cities in Kentucky are hiring for Remote Payment Integrity Analyst jobs?

Cities in Kentucky with the most Remote Payment Integrity Analyst job openings:

Remote Payment Integrity Analyst jobs near you

Senior Analyst, Payment Integrity Disputes

Louisville, KY • Remote

Oscar Health
Insurance Services • 1 - 5K employees

6.9

Company rating: 6.9 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

260th of 311 rated insurance

Respectful managers

Uninterrupted breaks

Learn more about Oscar Healthexternal

$64K - $85K/yr

Full-time

Posted 8 days ago

Job description

Hi, we're Oscar. We're hiring a Senior Analyst, Payment Integrity Disputes to join our Disputes team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role:

You will be responsible for supporting payment integrity disputes and issue resolution in the Oscar claim environment for both the Oscar Insurance business. You will scope, triage, investigate and execute on solutions and process improvements. You will leverage a deep understanding of Oscar's claim infrastructure, workflows, workflow tooling, platform logic, data models, etc., to work cross-functionally and understand and translate friction from stakeholders into actionable opportunities for improvement.

You will report into the Manager, Payment Integrity (Pre-Pay).

Work Location: This is a remote position, open to candidates who reside in: Atlanta, Georgia; Chicago, Illinois; Dallas, Texas; Louisville, Kentucky; Minneapolis, Minnesota; Philadelphia, Pennsylvania; Salt Lake City, Utah. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. #LI-Remote

Pay Transparency: The base pay for this role is: $64,832 - $85,092 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities:

  • Contribute as a subject matter expert for Oscar reimbursement policies, payment integrity disputes, internal claims processing edits and external vendor edits.
  • Respond to internal and external inquiries and disputes regarding policies and edits.
  • Research industry standard coding rules, summarize and provide input into reimbursement policy language and scope.
  • Use knowledge gained through research and claims review to ideate payment integrity opportunities. Translate into business requirements; submit to and collaborate with internal partners to effectuate change.
  • Ingest information from internal and external partners regarding adverse claim outcomes; collaborate with partners to scope, size, prioritize items and deliver solutions.
  • Use insights from partner submissions, data mining, process monitoring, etc., work with the team to proactively identify thematic areas of opportunity to solve problems.
  • Perpetuate a culture of transparency and collaboration by keeping stakeholders well informed of progress, status changes, blockers, completion, etc.; field questions as appropriate.
  • Support Oscar run state objectives by providing speedy research, root cause analysis, training, etc. whenever leadership escalates and assigns issues.
  • Compliance with all applicable laws and regulations
  • Other duties as assigned

Requirements:

  • Experience in Payment Integrity focused on Disputes and/or appeals
  • 4+ years of experience in claims processing, coding, auditing or health care operations
  • 3+ years experience in medical coding
  • Medical coding certification through AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA)
  • Experience with reimbursement methodologies, provider contract concepts and common claims processing/resolution practices.
  • 2+ years experience deriving business insights from datasets and solving problems
  • 1+ years experience improving business workflows and processes
  • 1+ years experience collaborating with internal and external stakeholders

Bonus points:

  • 2+ years experience in a technical role (QA analyst, PM, operations analyst, finance, consulting, industrial engineering) or a process improvement role (Six Sigma or similar)
  • 2+ years of experience working with large data sets using excel or a database language
  • Experience in a professional healthcare claims organization
  • Knowledge management, training, or content development in operational settings
  • Process Improvement or Lean Six Sigma training
  • Experience using SQL

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

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