To ensure the accuracy and compliance of healthcare claim payments across commercial, Medicare, and Medicaid lines of business, the full-time Payment Integrity Analyst will lead complex claim audits, develop claims editing rules, and monitor regulatory changes while working remotely. Key responsibilities Lead complex claim audits and investigations involving high-risk or high-value claims Design, develop, and maintain advanced claims editing rules and logic Monitor CMS, OIG, and regulatory updates to ensure organizational compliance Required qualifications Associate's or Bachelor's degree in Health Administration, Public Health, Business, or related field (or equivalent experience) 5+ years of experience in healthcare claims, payment integrity, auditing, or revenue cycle Advanced expertise in coding systems, reimbursement methodologies, and CMS regulations Strong experience with claims editing platforms (e.g., Optum CES) and advanced SQL skills Certifications such as CPC, CCS/CCS-P, or RHIT/RHIA are preferred