Top 253 Senior payment integrity Jobs in Riverside, Ca

Senior Payment Integrity Analyst
Inland Empire Health Plan —Rancho Cucamonga, CA
- $91,249.60 - $120,910.40 a year
- Full-time
- Remote
- HIPAA
- SQL
- Analysis skills
- Disability insurance
- Health insurance
2d
Senior Payment Integrity Program Development Specialist
Inland Empire Health Plan —Rancho Cucamonga, CA
- $80,059.20 - $106,059.20 a year
- Full-time
- Hybrid work
- Office
- SQL
- Analysis skills
- Disability insurance
- Health insurance
2d
Senior Accountant
QPA —Corona, CA
- $90,000 - $100,000 a year
- Management
- Writing skills
- Analysis skills
Quick Apply
Senior Data Scientist - AI Trainer
DataAnnotation —California
- $50 - $100 an hour
- Part-time
- Remote
- Computer Science
- English
- 3 years
- Flexible schedule
Quick Apply
Senior Quantitative Analyst - AI Trainer
DataAnnotation —California
- $50 - $100 an hour
- Part-time
- Remote
- Computer Science
- English
- Mid-level
- Flexible schedule
Quick Apply
Senior Trial Attorney
Travelers —Diamond Bar, CA
- $132,800 - $219,100 a year
- 7 years
- Writing skills
- Driver's License
- Wellness program
- Paid holidays
Senior Manager of Transmission Line Engineering
Leidos —California
- Full-time
- Civil engineering
- Office
- Travel
- Flexible schedule
- Referral program
6d
Senior Buyer / 62703
Sapphire Recruitment —Irvine, CA
- $32.50 - $50.00 an hour
- Email
- Oracle
- 5 years
- Analysis skills
Quick Apply
Sr. Business Systems Analyst - Oil (Commodity), Purchase, Planning, Trading
Ventura Foods —Irvine, CA
- $103,685.00 - $134,453.55 a year
- Hybrid work
- Oracle
- Engineering
- Analysis skills
- Profit sharing
- Paid holidays
Quick Apply
Care Partner
CLAREMONT PLACE —Claremont, CA
- $18 an hour
- Full-time
- Background check
- High school diploma or GED
- 21 years or older
- Disability insurance
- Health insurance
Quick Apply
5d
(USA) Senior Manager I, Asset Protection - All DC/FC
Walmart —Chino, CA
- $124,800 - $187,200 a year
- High school
- 3 years
- High school diploma or GED
- Paid jury duty
- Disability insurance
12d
(USA) Senior Operations Manager
Sam's Club —Perris, CA
- $127,600 - $191,400 a year
- High school
- Bachelor of Science
- Analysis skills
- Paid jury duty
- Disability insurance
Senior Demand Planner
Stryker —Irvine, CA
- $76,500 - $117,100 a year
- Full-time
- Mid-level
- SQL
- Bachelor's degree
- Health savings account
- AD&D insurance
Senior Manager - Risk Operations
Hard Rock Digital —Ontario, CA
- Full-time
- Remote
- 3 years
- Senior level
- Leadership
- Work from home
Quick Apply
Senior Accountant (2 Year Limited Term)
Inland Empire Utilities Agency —Chino, CA
- $120,456.13 - $146,764.18 a year
- Full-time
- 5 years
- Pass drug screening
- Office
- Profit sharing
- AD&D insurance
Senior Analyst
Martin Marietta —Corona, CA
- $100,000 - $128,000 a year
- Full-time
- Microsoft Excel
- 5 years
- Office
- Health savings account
- AD&D insurance
12d
(USA) Senior Technician, Facility Services, Food Equipment
Walmart —Perris, CA
- $36 - $69 an hour
- Carpentry
- 18 years or older
- Clean driving record
- Paid training
- Paid jury duty
3d
Senior Director, Quality Control (QC Head)
Gilead Sciences —La Verne, CA
- $221,000 - $286,000 a year
- Full-time
- 11+ years
- Bachelor's degree
- Doctor of Philosophy
- Health insurance
- Dental insurance
Senior Admission Representative-NWC-Riverside
Success Education Colleges —Riverside, CA
- $26 - $30 an hour
- Evenings as needed
- Microsoft Outlook
- Computer literacy
- Writing skills
Quick Apply
Patient Care Coordinator (Riverside)
SCAN Health Plan —Riverside, CA
- $20.00 - $27.50 an hour
- Full-time
- Remote
- Background check
- Spanish
- Current TB test
- Wellness program
- Paid holidays
Quick Apply

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senior payment integrity jobs near riverside, ca

Senior Payment Integrity Analyst

Inland Empire Health Plan -
Rancho Cucamonga, CA

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Job Details

Full-time
$91,249.60 - $120,910.40 a year
2 days ago

Benefits

457(b)
Disability insurance
Health insurance
On-site gym
Dental insurance
Flexible spending account
Vision insurance
Opportunities for advancement
Life insurance

Qualifications

Contract review
Health insurance policy knowledge
Contract interpretation
Financial data analysis tools
Data analysis software

Full Job Description

Overview:

What you can expect!

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

Reporting to the Manager, Payment Integrity Operations, the Senior Payment Integrity Analyst provides lead level analyst support to a team of Payment Integrity Analysts on daily operations of vendor(s) and internal programs for Payment Integrity. The incumbent provides quality assurance of junior analysts’ work and action on remediation plans to develop cost avoidance opportunities. This position leads the reporting and tracking of all vendor activity to provide daily and monthly reporting to management. The incumbent partners with leaders and functional representatives to drive health plan financial performance through evaluation and execution of operational initiatives tied to payment integrity (PI) and provider claims accuracy. The Senior Payment Integrity Analyst makes recommendations that inform decisions which contribute to health plan strategy, and acts as a trusted voice in assessing and assisting resolution of complex business challenges that impact cost-containment and regulatory compliance.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Additional Benefits:

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

Competitive salary
State of the art fitness center on-site
Medical Insurance with Dental and Vision
Life, short-term, and long-term disability options
Career advancement opportunities and professional development
Wellness programs that promote a healthy work-life balance
Flexible Spending Account – Health Care/Childcare
CalPERS retirement
457(b) option with a contribution match
Paid life insurance for employees
Pet care insurance

Key Responsibilities:

Audit and Investigation: Lead efforts to improve claim payment accuracy and financial performance. Review pre- and post-pay claims to identify overpayments, underpayments, and billing inaccuracies.
Data Analysis & Reporting: Develop and refine complex audit data mining techniques to detect irregularities, billing trends, and potential Fraud, Waste, and Abuse (FWA) and translate insights into actionable remediation strategies. Analyze large datasets using tools (SQL, Excel) to identify trends, anomalies, and root causes of payment errors. Design and maintain dashboards, trend analyses, and audit tracking tools to provide insight into payment error patterns, vendor performance, and program effectiveness.
Provider/Payer Collaboration: Work with providers to resolve payment discrepancies and defend or challenge reimbursement decisions.
Complex Auditing: Conduct comprehensive reviews of inpatient/outpatient claims, itemized bills, and DRGs (Diagnosis-Related Groups) to identify improper payments. Serve as a subject-matter expert for complex CMS/DHCS regulatory interpretation and operational application into PI audit strategies, system edits, and business rules.
Lead & Mentorship: Provide training, coaching, and QC (quality control) support to junior analysts to ensure accurate work.
Vendor Audit: Oversee vendor audit pipelines, validate findings, monitor performance metrics, generate financial impact reports, and ensure audit methodologies align with contractual and regulatory standards.
Compliance & Policy: Interpret and apply federal/state regulations (CMS) and provider contract terms for audits. Ensure regulatory requirements are met for pre-pay edits, post-payment datamining, and overpayment recovery.
Strategy & Improvement: Collaborate with leadership in the development of new audit concepts, test system edits, and collaborate on initiatives to reduce financial leakage.
Appeal Management: Analyze and resolve provider inquiries and appeals regarding payment adjustments. Prepare comprehensive appeal defense packages, analyze overturn trends, and recommend process improvements to strengthen audit defensibility.
Perform any other duties as required to ensure Health Plan operations and department business needs are successful.

Qualifications:

Education & Requirements

A minimum of five (5) years of experience in a combination of payment integrity, claims auditing, and/or medical coding required
Strong data analysis/queries experience
Experience with contract and Division of Financial Responsibility (DOFR) interpretation
Bachelor’s degree in business, health administration, or a related field from an accredited institution required
- In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this position
- This experience is in addition to the minimum years listed in the Experience Requirements above
Certification in RHIA, RHIT, CCS, CPC, CIC or similar certification preferred

Key Qualifications

Strong knowledge and deep understanding of:
- Billing regulations (CMS, HIPAA), DRG, ICD-10, and CPT coding
- Medical coding (CPT, ICD-10, HCPCS) and health insurance contracts
- The full claims lifecycle, including share of cost and coordination of benefits
- Medicaid/Medi-Cal or Medicare regulatory frameworks
- Payment integrity concepts (pre-pay audit, post-pay audit types, DRG validation, coordination of benefits and comparable concepts)
- Data file layouts and system configurations to troubleshoot and coordinate remediation efforts with IT and vendors
Strong analytical skills with the ability to analyze large datasets and identify patterns
Strong proficiency in SQL, data visualization tools, and MS Excel
Strong written and verbal communication skills, including ability to synthesize complex information
Proven ability to:
- Analyze data to inform business decisions
- Work independently and apply business judgment in a highly regulated, cross-functional environment

Start your journey towards a thriving future with IEHP and apply TODAY!

Work Model Location:

Telecommute (All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership)

Pay Range: USD $91,249.60 - USD $120,910.40 /Yr.

Apply Now

Refine Your Search

senior payment integrity jobs in riverside, ca

Senior Payment Integrity Analyst

Senior Payment Integrity Program Development Specialist

Senior Accountant

Senior Data Scientist - AI Trainer

Senior Quantitative Analyst - AI Trainer

Senior Trial Attorney

Senior Manager of Transmission Line Engineering

Senior Buyer / 62703

Sr. Business Systems Analyst - Oil (Commodity), Purchase, Planning, Trading

Care Partner

(USA) Senior Manager I, Asset Protection - All DC/FC

(USA) Senior Operations Manager

Senior Demand Planner

Senior Manager - Risk Operations

Senior Accountant (2 Year Limited Term)

Senior Analyst

(USA) Senior Technician, Facility Services, Food Equipment

Senior Director, Quality Control (QC Head)

Senior Admission Representative-NWC-Riverside

Patient Care Coordinator (Riverside)

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