Medical Economics Analyst – Payment Integrity

🕒 August 7

🌶️ New Mexico – Remote

🌶️ New Mexico – Remote

💵 $87.5k - $149k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🧐 Analyst

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 14%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Presbyterian Healthcare Services

WebsiteLinkedInAll Job Openings

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 to support pre-pay and post-pay initiatives • Analyze claims data to identify overpayments, billing anomalies, and coding discrepancies • Support development and refinement of rules, algorithms, and audit strategies • Translate payment integrity activities into measurable financial outcomes tied to total cost of care objectives • 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 • 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 • Build repeatable datasets and analytic pipelines in enterprise data warehouse environments • Develop dashboards and reporting tools to monitor 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 • Develop executive-ready summaries highlighting 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 (required) • Experience querying large relational databases • Experience working with claims data and reimbursement methodologies, including fee schedules, IPPS, and OPPS • Demonstrated 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 through wellness program • Wellness challenges • Wellness webinars • Preventive screening opportunities • Full-time employment • Weekday schedule, Monday-Friday