Medical Economics Analyst – Payment Integrity

🕒 May 26

🌶️ New Mexico – Remote

🌶️ New Mexico – Remote

💵 $83.4k - $127.3k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🧐 Analyst

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Presbyterian Healthcare Services

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1908

⚕️ Healthcare Insurance

🤝 Non-profit

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

• The Payment Integrity Medical Economics Analyst plays a critical role in identifying, quantifying, and validating medical cost savings opportunities through deep partnership with the Payment Integrity team. • This role combines advanced analytics, claims validation, and financial insight to ensure accuracy of payments, integrity of savings initiatives, and alignment to total cost of care (TCOC) objectives. • This individual will leverage enterprise data assets, including claims and provider data, to produce actionable insights, validate recoveries, and support pre- and post-pay integrity initiatives. • 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

🎯 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 (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 • optional voluntary benefits • wellness program