Payment Integrity Operations Analyst IV
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AI Summary
Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.
We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.
The Payment Integrity Operations Analyst IV is responsible for supporting and executing payment integrity operations, including program monitoring, data validation, issue identification and resolution, and reporting. This role partners cross-functionally to drive financial accuracy, operational excellence, and a positive provider and member experience. Performs other duties assigned.
This is a senior-level individual contributor role that also provides guidance to team members and serves as a subject matter expert within payment integrity operations.
Key Responsibilities
- Oversee day-to-day payment integrity operations, ensuring accuracy and efficiency across processes
- Monitor payment integrity programs and analyze performance to identify trends, risks, and improvement opportunities
- Conduct data validation and audits to ensure financial and operational accuracy
- Investigate and resolve complex issues related to claims, payments, and program outputs
- Develop and maintain reporting to support decision-making and operational insights
- Collaborate with cross-functional teams (e.g., operations, analytics, clinical, compliance) to resolve issues and optimize processes
- Provide guidance and direction to team members and support achievement of team goals
- Contribute to process improvements and drive operational best practices
Required Qualifications
- Bachelor’s degree or equivalent combination of education and work experience
- 7+ years of relevant professional experience (beyond degree)
Preferred Qualifications
- 5+ years of relevant coding experience
- Certified Coder with demonstrated experience in both professional (physician) and facility coding
Skills and Abilities
- Advanced knowledge of payment integrity, healthcare operations, or related field
- Strong analytical and problem-solving skills with the ability to work on complex issues
- Experience with data analysis, reporting, and operational performance monitoring
- Ability to act as a subject matter expert and provide guidance to others
- Strong communication and cross-functional collaboration skills
This position is a Remote role. To be eligible for consideration, candidates must have a primary home address located within any state where Medica is registered as an employer - AR, AZ, FL, GA, IA, IL, KS, KY, MI, MN, MO, ND, NE, OK, SD, TN, TX, VA, WI
The full salary grade for this position is $62,700 - $107,500. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $62,700 - $94,080. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.
The compensation and benefits information is provided as of the date of this posting. Medica’s compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.
Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.
We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.
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