Senior Analyst, Edits | Payment Integrity (remote)houston, Tx

CGI

Knoxville, Tennessee, United States
Base: $75,000.00 - $100,000.00; bonus/equity: not ...
Fully remote
Claim data analysis
Medical policy translation
Rule specifications design
CGI is seeking a Senior Analyst for their Edits team, focusing on payment integrity and the development of an edits library to prevent improper payments in healthcare. The role requires strong coding expertise and analytics skills, along with a commitment to compliance and collaboration across teams

Job Summary

  • You will manage the full lifecycle of edit development—from initial opportunity identification to rules design, clinical validation, and deployment.
  • Partner with Medical Directors and internal auditors (RNs/Coders) to ensure clinical appropriateness and strict compliance with CMS coding policies.
  • CGI offers competitive compensation, comprehensive insurance options, matching contributions through the 401(k) plan, and paid time off.

Matching Summary

Match Score: 85

CGI is seeking a Senior Analyst for their Edits team, focusing on payment integrity and the development of an edits library to prevent improper payments in healthcare. The role requires strong coding expertise and analytics skills, along with a commitment to compliance and collaboration across teams.

Salary

Base: $75,000.00 - $100,000.00; Bonus/Equity: Not specified; Benefits: Comprehensive insurance, 401(k) matching, paid time off

Skills & Requirements

Must-have

  • Claim data analysis
  • Medical policy translation
  • Rule specifications design
  • User acceptance testing
  • Performance tracking
  • Clinical appropriateness validation
  • CMS coding policies compliance

Nice-to-have

  • Teamwork and respect
  • Ownership from day one
  • Global capabilities access
  • Career shaping opportunities
  • Supportive leadership

Key Requirements

  • Active CCS or CPC certification
  • 5+ years in payment integrity, claims analytics, medical policy, or coding
  • Expertise in CPT/HCPCS, ICD-10, DRG, APC/OPPS, NCCI
  • Experience in prepay editing or post-pay audit logic
  • Bachelor’s degree or equivalent experience

Work Rights

Not specified

Tailored Resume

Cover Letter