Payment Integrity Analytics Analyst
Seeking a hands-on Analyst / Consultant Data Engineer Analytics to support data engineering, analytics enablement, and reporting for our Payment Integrity product suite. This role will focus on building and maintaining reliable data pipelines, analytics-ready data models, reconciliation workflows, and operational reporting that support clinical reviews, itemized bill review, repricing, evidence generation, and client-facing value measurement.
The ideal candidate brings strong SQL and Python skills, practical healthcare data experience, and the ability to work across claims, clinical, provider, eligibility, chart, and review workflow datasets. This role requires a detail-oriented engineer who can translate product and operational requirements into scalable, auditable, and reusable analytics solutions.
Key Responsibilities
Payment Integrity Analytics & Data Engineering
- Develop and maintain analytics data pipelines supporting Payment Integrity workflows, including clinical audit, itemized bill review, chart-to-claim validation, and repricing outputs.
- Ingest, normalize, and reconcile payer, provider, claims, chart, bill, evidence, and review decision data for downstream analytics and reporting.
- Create analytics-ready data models that support reviewer productivity, audit outcomes, savings opportunity analysis, repricing logic, and client value reporting.
- Analyze Payment Integrity performance trends and create recurring and ad hoc reports for clinical reviews, reviewer productivity, savings opportunities, outcomes, and operational KPIs.
- Support data validation, exception handling, and reconciliation frameworks to ensure accuracy across source files, platform data, and reporting outputs.
Reviewer Workbench & Product Enablement
- Partner with Product and Clinical teams to enable Reviewer Workbench analytics, including work queues, case status, reviewer actions, evidence bundles, and decision outcomes.
- Translate Payment Integrity product requirements into backend datasets, dashboards, metrics, and operational reporting structures.
- Develop and maintain analytical reports, dashboards, and summary views that help stakeholders understand business performance, data quality, and product impact.
- Support measurement of clinical review performance, line-level outcomes, turnaround times, QA findings, and HRP handoff readiness.
- Assist with analytics needs for new product features, AI-assisted review workflows, and audit trail enhancements.
Platform Optimization & Delivery
- Build reusable SQL and Python components for ingestion, transformation, quality checks, and reporting automation.
- Optimize queries, tables, and scheduled jobs for performance, cost, and reliability.
- Monitor data pipelines and investigate failures, anomalies, or unexpected trends with clear root-cause documentation.
- Maintain documentation for datasets, transformations, reporting logic, and operational runbooks.
Cross-Functional Collaboration
- Work closely with Engineering, Analytics, Clinical Operations, Product, and Client Delivery teams to support Payment Integrity implementation and reporting needs.
- Participate in requirements refinement, data mapping sessions, issue triage, and release validation activities.
- Communicate findings clearly to technical and non-technical stakeholders, including data limitations, assumptions, and recommended next steps.
Compliance & Data Governance
- Ensure all data engineering and analytics workflows follow HIPAA, security, and least-privilege access expectations.
- Implement validation checks, auditability, and traceability across data pipelines and reporting outputs.
- Support de-identification, retention, and controlled access practices where applicable.
FAQs
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