Presbyterian Healthcare Services
Medical Economics Analyst-Payment Integrity
RemoteUnited States, Mexico, Argentina only
- Role
- Data Engineering
- Experience
- Mid
- Employment
- Full-time
- Company size
- Enterprise
$87.5k–$149k/yr
Check eligibility
Open to US, MX, AR only. Set where you work from to check your eligibility.
No BS summary
Mid-level healthcare data analyst focused on payment integrity and medical economics. Needs strong SQL and/or SAS skills and experience with claims data and reimbursement methodologies. Remote but hiring for New Mexico-based workers; must align validated savings to finance.
Core skills
SQLSASclaims data analysis
Required skills
claims datarelational databasesfinancial analysisstatistical analysis
Optional skills
experience with Cotivitiexperience with Optumexperience with fee schedulesIPPSOPPSdashboard and reporting tools
What you'll do
- 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
What they require
- 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
Benefits
- Medical, dental, vision
- Short-term and long-term disability
- Group term life insurance
- Other optional voluntary benefits
- Employee Wellness rewards program (earn gift cards, wellness activities)
- Comprehensive benefits package for benefits-eligible employees
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.
$87.5k–$149k/yr