Payment Integrity Analyst II

St. Jude Children's Research Hospital

. Reviews claim payments for accuracy through prepayment edits, audits, contract-compliance reviews, and post-payment payment-integrity solutions .

Posted 10/30/2026full-timeBellaire • Texas • United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in claims payment accuracy, overpayment recovery strategies, and payment integrity solutions within the health care sector. Proficient in analyzing claims data and collaborating with cross-functional teams to enhance payment policies and coding edits.

Highest-signal resume keywords

Claims Editing ExperienceHealth Care Data AnalysisOverpayment Recovery StrategiesProject Implementation ExperienceCertified Coding Specialist

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims Payment AccuracyOverpayment IdentificationData MiningPayment-Integrity SolutionsClaims-Editing SoftwareContract Compliance ReviewsPayment Policy EditsCoding GuidanceInvoice ProcessingQuality Assurance Activities

Soft Skills

MentoringCollaborationProblem SolvingCommunicationResourcefulness

Tools & Technologies

Claims-Payment AlgorithmsVendor Management SystemsData Analysis ToolsQuality Metrics Monitoring

Certifications & Qualifications

Certified Coding SpecialistCertified Coding Specialist Physician-BasedRegistered Health Information Administrator

Industry Keywords

Health Care Payer ProgramsMedicareMedicaidCommercial PlansPayment IntegrityClaims Data TrendsCost-Avoidance Initiatives

About the role

Key responsibilities & impact

Reviews claim payments for accuracy through prepayment edits, audits, contract-compliance reviews, and post-payment payment-integrity solutions
Supports overpayment identification, recovery, remediation, and prevention activities
Analyzes overpayment, refund, and claims data to identify trends, savings opportunities, and potential payment-integrity initiatives
Develops and supports strategies that recover overpayments and establish controls to prevent future payment errors
Tracks, analyzes, and ensures accurate and timely processing of payment-integrity invoices
Supports retrospective data mining and prospective cost-avoidance initiatives
Serves as a resource and mentor for team members
Assists with customization of claims-payment algorithms and edits
Supports vendor implementations, configurations, quality assurance activities, and ongoing oversight
Coordinates with vendors and internal teams to maintain payment-integrity solutions and improve claims-payment accuracy
Collaborates with content, technical, and data teams to develop, adjust, validate, and maintain payment-policy edits
Responds to escalated internal and external inquiries, provider disputes, and payment-integrity research requests
Monitors vendor file submissions, invoicing, quality metrics, and performance against established expectations
Identifies payment-integrity issues, evaluates evidence and data, and recommends technical or process improvements
Reviews health care policies and coding guidance to identify billing and coding rules appropriate for claims-edit development
Translates policy requirements into specifications for software coding edits and validates that edits function as intended

Requirements

What you’ll need

High school diploma required
Three or more years of health care data experience required
Two or more years of experience participating in health care payer programs, including Medicare, Medicaid, or commercial plans, required
Two or more years of claims-editing experience with health care payers or claims-editing software vendors required
Project implementation experience required
Bachelor’s degree preferred
Certified Coding Specialist, Certified Coding Specialist Physician-Based, or Registered Health Information Administrator certification preferred