Presbyterian Healthcare Services
10,000+ employees
Founded 1908
🏥 Healthcare
⚕️ Healthcare Insurance
🤝 Non-profit
Healthcare • Healthcare Insurance • Non-profit
Presbyterian Healthcare Services is an integrated, nonprofit healthcare system based in New Mexico that operates hospitals, urgent care clinics, specialty and primary care practices, virtual care (VirtualPRES), and health insurance plans. The organization provides a broad range of clinical services—including neuroscience, transplant, cancer care, surgery, behavioral health, and home health—while also running community health and charitable programs (financial assistance, community support, and partnerships with medical education). It offers individual, Medicaid, Medicare Advantage, and employer health plans, plus patient tools (MyChart/myPRES), billing support, and commitment to access and quality across the state.
Medical Economics Analyst – Payment Integrity
🕒 August 7
🌶️ New Mexico – Remote
💵 $87.5k - $149k / year
⏰ Full Time
🟢 Junior
🟡 Mid-level
🧐 Analyst
🦅 H1B Visa Sponsor
📊 Check your resume score for this job
Improve your chances of getting an interview by checking your resume score before you apply.
Presbyterian Healthcare Services
10,000+ employees
Founded 1908
🏥 Healthcare
⚕️ Healthcare Insurance
🤝 Non-profit
Healthcare • Healthcare Insurance • Non-profit
Presbyterian Healthcare Services is an integrated, nonprofit healthcare system based in New Mexico that operates hospitals, urgent care clinics, specialty and primary care practices, virtual care (VirtualPRES), and health insurance plans. The organization provides a broad range of clinical services—including neuroscience, transplant, cancer care, surgery, behavioral health, and home health—while also running community health and charitable programs (financial assistance, community support, and partnerships with medical education). It offers individual, Medicaid, Medicare Advantage, and employer health plans, plus patient tools (MyChart/myPRES), billing support, and commitment to access and quality across the state.
📋 Description
• Partner with Payment Integrity, Operations, and vendor partners such as Cotiviti and Optum on pre-pay and post-pay initiatives • Analyze claims data to identify overpayments, billing anomalies, and coding discrepancies • Support development and refinement of payment-integrity rules, algorithms, and audit strategies • Translate operational payment-integrity activities into measurable financial outcomes tied to total cost of care • Validate savings opportunities through claims-level analysis and audit review • Develop and maintain methodologies to quantify gross and net savings • Perform before/after and control-group analyses to validate savings estimates • Partner with Finance to align validated savings with general-ledger and financial reporting • Extract, transform, and analyze large healthcare datasets • Build repeatable datasets and analytic pipelines in enterprise data warehouse environments • Develop dashboards and reporting tools for payment-integrity performance and trends • Support integration of external/vendor outputs into internal analytics frameworks • Produce reporting on payment-integrity performance, savings, and emerging opportunities • Prepare executive-ready summaries of key drivers, risks, and recommended actions • Monitor initiative performance and identify new opportunities • Generate pre-payment edit contribution invoices for Self-Funded accounts
🎯 Requirements
• 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 • Experience querying large relational databases • Experience working with claims data and reimbursement methodologies, including fee schedules, IPPS, and OPPS • Ability to perform financial and statistical analysis on large datasets • Strong problem-solving skills • Attention to detail and data accuracy
🏖️ Benefits
• Medical insurance • Dental insurance • Vision insurance • Short-term disability insurance • Long-term disability insurance • Group term life insurance • Optional voluntary benefits • Employee Wellness rewards program • Gift cards and more through wellness activities • Wellness challenges • Wellness webinars • Preventive screenings
Apply NowSimilar Jobs
🕒 August 7
New Client Intake and Conflicts Analyst supporting client intake, conflict searches, and matter management for MGC, a multi-office civil litigation firm. Maintaining accurate Aderant records and opening new files remotely.
🕒 August 7
Merchant KYB Analyst investigating business ownership, sanctions, fraud, and reputational risk for Breeze’s universal fiat-and-crypto payment platform. Supporting compliant merchant onboarding and scalable risk operations.
🕒 August 7
Data Integrity Analyst maintaining EMPI, chart corrections, and patient records for OhioHealth healthcare system. Resolving duplicates, overlays, and MRN issues across Epic and connected health information systems.
🕒 August 7
HRIS Analyst optimizing Workday and HR systems for Ivy Rehab’s network of therapy clinics. Resolving issues, improving processes, developing reports, and coordinating system testing.
🕒 August 7
Assessment Analyst conducting FedRAMP, PCI, ISO, and NIST-based cloud security assessments for Fortreum, a cloud and cybersecurity services provider. Documenting findings, testing controls, and delivering client-facing assessment work.
