Senior Healthcare Payment Integrity Analytics Consultant

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Senior Healthcare Payment Integrity Analytics Consultant

Initial 6-Month Contract Rate: $60 per hour

Overview

We are seeking an experienced Senior Healthcare Payment Integrity Analytics Consultant to support the development of advanced analytical solutions focused on improving claims accuracy and identifying payment discrepancies across healthcare reimbursement programmes.

This role combines healthcare domain expertise with data analytics and audit methodologies to design scalable solutions that enhance payment integrity, support compliance initiatives, and drive operational efficiencies. The successful candidate will work closely with a range of business, clinical, and technical stakeholders to deliver high-impact insights and innovative recovery strategies.

Key Responsibilities

Design and implement data mining and analytical solutions to identify payment inaccuracies and overpayments across healthcare claims.

Develop and refine algorithms that detect billing, coding, reimbursement, and contractual payment discrepancies.

Research and interpret healthcare regulations, industry standards, and reimbursement guidelines to support analytics development.

Analyse provider agreements and reimbursement methodologies to identify opportunities for payment recovery and accuracy improvements.

Configure and deploy payment analytics solutions for both new and existing client environments.

Provide subject matter expertise to support validation, appeals, operations, and client-facing teams.

Act as a senior team member, providing mentorship and guidance to junior analysts.

Review analytical outputs and support quality assurance activities to ensure accuracy and effectiveness of developed solutions.

Produce clear documentation, reports, presentations, and business recommendations based on analytical findings.

Collaborate with operational, clinical, and technology teams to improve audit methodologies and enhance payment integrity processes.

Partner with technical teams to identify and implement automation and process improvement opportunities.

Contribute innovative ideas that strengthen existing analytics frameworks, audit strategies, and recovery programmes.

Required Experience & Skills

Minimum 5 years’ experience in healthcare payment integrity, healthcare analytics, claims auditing, or data mining.

At least 3 years’ experience analysing healthcare claims within one or more of the following areas:

Medical Claims

Dental Claims

Pharmacy Claims

Strong understanding of healthcare reimbursement methodologies, billing practices, and claims processing.

Experience applying healthcare regulations, coding standards, and reimbursement guidelines within an audit or analytical environment.

Demonstrated ability to translate complex policy and regulatory requirements into scalable analytical solutions.

Strong analytical, problem-solving, and stakeholder management skills.

Experience reviewing and validating claims data, payment accuracy, and audit findings is highly desirable.

Previous experience within payment recovery, payment integrity, healthcare auditing, or compliance-focused environments is advantageous.

Contract Details

Contract Length: Initial 6 months

Rate: $60 per hour

Type: Contract

This role would suit a senior healthcare analytics professional with a strong background in payment integrity, claims auditing, data mining, and healthcare reimbursement analysis who enjoys solving complex challenges and driving measurable financial and operational outcomes.

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