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Senior Payment Integrity Analyst Jobs (NOW HIRING)

Modivcare, Inc.

Payment Integrity Analyst

$24.88 - $32/hr

The Payment Integrity Analyst is responsible for reviewing non-emergency medical transportation (NEMT) claims to identify potential fraud, waste, and abuse (FWA), billing discrepancies, and payment ...

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 ...

InnovAge

Payment Integrity Analyst

Denver, CO · On-site

$77K - $116K/yr

Responsibilities The Payment Integrity Analyst provides quality and operational support for PACE program administration, including claims auditing support, testing, data analysis, issue resolution ...

InnovAge

Payment Integrity Analyst

Denver, CO · On-site +1

$77K - $96K/yr

Responsibilities The Payment Integrity Analyst provides quality and operational support for PACE program administration, including claims auditing support, testing, data analysis, issue resolution ...

InnovAge

Payment Integrity Analyst

Denver, CO · On-site +1

$77K - $96K/yr

Responsibilities The Payment Integrity Analyst provides quality and operational support for PACE program administration, including claims auditing support, testing, data analysis, issue resolution ...

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 ... For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level ...

CERiS

Payment Integrity Analyst II

Fort Worth, TX · On-site

$66K - $101K/yr

The Payment Integrity Analyst is responsible for accurately reviewing pre and post pay claim audits ... For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level ...

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Senior Payment Integrity Analyst information

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$53.5K

$109.8K

$142.5K

How much do senior payment integrity analyst jobs pay per year?

As of Aug 25, 2026, the average yearly pay for senior payment integrity analyst in the United States is $109,846.00, according to ZipRecruiter salary data. Most workers in this role earn between $90,500.00 and $137,000.00 per year, depending on experience, location, and employer.

What is a senior payment integrity analyst?

A Senior Payment Integrity Analyst is a professional responsible for ensuring that healthcare or financial claims are accurate, compliant, and free of errors or fraud. They analyze large datasets to identify discrepancies, overpayments, underpayments, or potentially fraudulent activity. Senior analysts often lead investigations, collaborate with internal teams, and recommend process improvements to enhance payment accuracy and reduce financial risk. This role typically requires strong analytical skills, knowledge of industry regulations, and experience with claims processing systems.

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

To thrive as a Senior Payment Integrity Analyst, you need strong analytical abilities, in-depth knowledge of healthcare claims processing, and experience in data analysis, often supported by a degree in finance, healthcare administration, or a related field. Familiarity with claims adjudication systems, data mining tools like SAS or SQL, and certification such as Certified Professional Coder (CPC) is typically required. Excellent problem-solving, attention to detail, and strong communication skills are essential for identifying errors and collaborating with cross-functional teams. These skills ensure accurate claims processing, minimize financial losses, and support regulatory compliance in healthcare organizations.

What are the main challenges a senior payment integrity analyst might face when working with cross-functional teams?

A Senior Payment Integrity Analyst often works closely with teams such as claims processing, IT, and compliance. One of the main challenges in this collaborative environment is ensuring clear communication and alignment on complex data and regulatory requirements. Analysts must often translate analytical findings into actionable recommendations for non-technical colleagues, which requires strong interpersonal skills and adaptability. Navigating different priorities and timelines across departments can also be challenging, but it provides valuable experience in project management and cross-functional leadership.

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

AspectSenior Payment Integrity AnalystPayment Integrity Analyst
Required CredentialsBachelor's degree, certifications like CPC or CPHQ often preferredBachelor's degree, relevant certifications optional
Work EnvironmentHealthcare or insurance companies, government agenciesHealthcare insurers, third-party administrators
Employer & Industry UsageUsed in healthcare, insurance, government sectorsCommon in healthcare insurance companies
Comparison Search IntentUnderstanding senior roles and responsibilitiesEntry to mid-level payment integrity roles

The Senior Payment Integrity Analyst typically has more experience, advanced certifications, and handles complex cases, whereas the Payment Integrity Analyst focuses on routine audits and claims review. Both roles are vital in healthcare and insurance sectors, but the senior position involves greater responsibility and oversight.

How much does a senior payment integrity analyst make?

A senior payment integrity analyst typically earns between $70,000 and $100,000 annually, depending on experience, location, and industry. They often require strong analytical skills and familiarity with healthcare or financial systems to perform audits and identify payment discrepancies.
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Senior Payment Integrity Analyst jobs near you
Infographic showing various Senior Payment Integrity Analyst job openings in the United States as of August 2026, with employment types broken down into 100% Full Time. Highlights an 50% In-person, and 50% Remote job distribution, with an average salary of $109,846 per year, or $52.8 per hour.

Senior Payment Integrity Analyst

Inland Empire Health Plan

Rancho Cucamonga, CA • On-site, Remote

$91K - $120K/yr

Full-time

Medical, Dental, Vision, Life, Retirement

Posted 5 days ago

Inland Empire Health Plan rating

6.8

Company rating: 6.8 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

268th of 311 rated insurance

Job description

Overview
What you can expect!
Find joy in serving others with IEHP! We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an authentic experience!
Reporting to the Manager, Payment Integrity Operations, the Senior Payment Integrity Analyst provides lead level analyst support to a team of Payment Integrity Analysts on daily operations of vendor(s) and internal programs for Payment Integrity. The incumbent provides quality assurance of junior analysts' work and action on remediation plans to develop cost avoidance opportunities. This position leads the reporting and tracking of all vendor activity to provide daily and monthly reporting to management. The incumbent partners with leaders and functional representatives to drive health plan financial performance through evaluation and execution of operational initiatives tied to payment integrity (PI) and provider claims accuracy. The Senior Payment Integrity Analyst makes recommendations that inform decisions which contribute to health plan strategy, and acts as a trusted voice in assessing and assisting resolution of complex business challenges that impact cost-containment and regulatory compliance.
Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.
Additional Benefits
Perks
IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.
  • Competitive salary
  • State of the art fitness center on-site
  • Medical Insurance with Dental and Vision
  • Life, short-term, and long-term disability options
  • Career advancement opportunities and professional development
  • Wellness programs that promote a healthy work-life balance
  • Flexible Spending Account - Health Care/Childcare
  • CalPERS retirement
  • 457(b) option with a contribution match
  • Paid life insurance for employees
  • Pet care insurance

Key Responsibilities
  1. Audit and Investigation: Lead efforts to improve claim payment accuracy and financial performance. Review pre- and post-pay claims to identify overpayments, underpayments, and billing inaccuracies.
  2. Data Analysis & Reporting: Develop and refine complex audit data mining techniques to detect irregularities, billing trends, and potential Fraud, Waste, and Abuse (FWA) and translate insights into actionable remediation strategies. Analyze large datasets using tools (SQL, Excel) to identify trends, anomalies, and root causes of payment errors. Design and maintain dashboards, trend analyses, and audit tracking tools to provide insight into payment error patterns, vendor performance, and program effectiveness.
  3. Provider/Payer Collaboration: Work with providers to resolve payment discrepancies and defend or challenge reimbursement decisions.
  4. Complex Auditing: Conduct comprehensive reviews of inpatient/outpatient claims, itemized bills, and DRGs (Diagnosis-Related Groups) to identify improper payments. Serve as a subject-matter expert for complex CMS/DHCS regulatory interpretation and operational application into PI audit strategies, system edits, and business rules.
  5. Lead & Mentorship: Provide training, coaching, and QC (quality control) support to junior analysts to ensure accurate work.
  6. Vendor Audit: Oversee vendor audit pipelines, validate findings, monitor performance metrics, generate financial impact reports, and ensure audit methodologies align with contractual and regulatory standards.
  7. Compliance & Policy: Interpret and apply federal/state regulations (CMS) and provider contract terms for audits. Ensure regulatory requirements are met for pre-pay edits, post-payment datamining, and overpayment recovery.
  8. Strategy & Improvement: Collaborate with leadership in the development of new audit concepts, test system edits, and collaborate on initiatives to reduce financial leakage.
  9. Appeal Management: Analyze and resolve provider inquiries and appeals regarding payment adjustments. Prepare comprehensive appeal defense packages, analyze overturn trends, and recommend process improvements to strengthen audit defensibility.
  10. Perform any other duties as required to ensure Health Plan operations and department business needs are successful.

Qualifications
Education & Requirements
  • A minimum of five (5) years of experience in a combination of payment integrity, claims auditing, and/or medical coding required
  • Strong data analysis/queries experience
  • Experience with contract and Division of Financial Responsibility (DOFR) interpretation
  • Bachelor's degree in business, health administration, or a related field from an accredited institution required
    • In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this position
    • This experience is in addition to the minimum years listed in the Experience Requirements above
  • Certification in RHIA, RHIT, CCS, CPC, CIC or similar certification preferred

Key Qualifications
  • Strong knowledge and deep understanding of:
    • Billing regulations (CMS, HIPAA), DRG, ICD-10, and CPT coding
    • Medical coding (CPT, ICD-10, HCPCS) and health insurance contracts
    • The full claims lifecycle, including share of cost and coordination of benefits
    • Medicaid/Medi-Cal or Medicare regulatory frameworks
    • Payment integrity concepts (pre-pay audit, post-pay audit types, DRG validation, coordination of benefits and comparable concepts)
    • Data file layouts and system configurations to troubleshoot and coordinate remediation efforts with IT and vendors
  • Strong analytical skills with the ability to analyze large datasets and identify patterns
  • Strong proficiency in SQL, data visualization tools, and MS Excel
  • Strong written and verbal communication skills, including ability to synthesize complex information
  • Proven ability to:
    • Analyze data to inform business decisions
    • Work independently and apply business judgment in a highly regulated, cross-functional environment

Start your journey towards a thriving future with IEHP and apply TODAY!
Work Model Location
Telecommute (All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP's main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership)
Pay Range
USD $91,249.60 - USD $120,910.40 /Yr.

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