Payment Integrity Business Analyst

PLEASE NOTE BEFORE APPLYING: CODOXO IS NOT ABLE TO OFFER SPONSORSHIP OR ACCOMMODATE ANY CANDIDATES THAT ARE CURRENTLY BEING SPONSORED NOW OR IN THE FUTURE About Codoxo Of the $3.8T we spend on healthcare in the United States annually, about a third of it is estimated to be lost due to waste, fraud and abuse. Codoxo is the premier provider of artificial intelligence-driven solutions and services that help healthcare companies and agencies proactively detect and reduce risks from fraud, waste, and abuse and ensure payment integrity. Codoxo helps clients manage costs across network management, clinical care, provider coding and billing, payment integrity, and special investigation units. Our software-as-a-service applications are built on our proven Forensic AI Engine, which uses patented AI-based technology to identify problems and suspicious behavior far faster and earlier than traditional techniques. We are venture backed by some of the top investors in the country, with strong financials, and remain one of the fastest growing healthcare AI companies in the industry. Position Summary The Payment Integrity Business Analyst sits within the Customer Success Team and will play a key role in supporting Codoxo’s Payment Integrity SaaS solutions and ensuring suscessful client adoption and operational value. This role serves as a bridge between customer success teams and product management, helping translate customer needs into actionable insights, enhanced workflows, and platform enhancements. The Payment Integrity Business Analyst will support client implementations, assist in the operationalization of in-house data mining concepts, and help document, design and submit tickets for new product capabilities. This role requires a strong understanding of healthcare claims data, payment integrity workflows, and healthcare reimbursement methodologies. The ideal candidate is a highly motivated problem solver with strong analytical ability, excellent communication skills, and experience working with healthcare claims data and analytics platforms. Key Responsibilities Customer Success & Client Engagement Support Customer Success teams in the implementation and optimization of Codoxo Payment Integrity SaaS solutions. Assist clients in understanding platform capabilities and analytical outputs. Help translate client and internal business needs into platform configuration requirements and operational workflows. Participate and/or lead client meetings, demonstrations, and solution reviews. Data Mining Operations Support Collaborate with internal data mining teams to support the identification and development of new Payment Integrity concepts and system functionality. Assist with documentation of analytical methodologies and audit specifications. Support the operationalization of data mining concepts into scalable workflows within the Codoxo platform. Validate data outputs and assist with the preparation of client-facing deliverables. Product Development & Platform Enhancements Gather and document business requirements for new platform capabilities and enhancements. Work closely with product and engineering teams to translate operational needs into technical specifications. Assist product management backlog development, user story creation, and prioritization of product features. Support user acceptance testing (UAT) for new platform functionality. Cross-Functional Collaboration Act as a liaison between Customer Success, Data Mining, Product, and Engineering teams. Document workflows, operational processes, and product requirements. Proactively identify opportunities to improve product usability, automation, and analytical workflows. Qualifications Bachelor’s degree in Business, Healthcare Administration, Data Analytics, Information Systems, or related field. 3+ years of experience working with healthcare claims data, payment integrity, healthcare analytics, or health plan operations. Strong understanding of healthcare claims including CPT, HCPCS, and ICD-10 coding structures. Experience analyzing healthcare claims data or supporting Payment Integrity programs. Strong analytical and problem-solving skills. Remote Work Requirements: To ensure reliable performance on the company-issued CODOXO laptop, employees working remotely must have a stable high-speed internet connection. Internet performance should be measured using a speed test conducted directly on the CODOXO laptop, not based solely on the internet plan purchased from the provider. Preferred Qualifications Experience working with Payment Integrity programs including, but not limited to: case/audit tracking software, analytic capabilities, edits, rules, fraud, waste, and abuse detection. Experience supporting healthcare SaaS platforms or analytics tools. Familiarity with SQL, Python, PowerBI, Tableau or other data analysis/query tools. Knowledge of Medicare, Medicaid, and Commercial reimbursement methodologies and audit capabilities Technical Skills Proficient in Microsoft Office Suite Experience with data analytics tools or SQL-based environments preferred Familiarity with Conflluence, Jira, SharePoint, and AWS is desirable Physical Requirements Work is performed in an office environment (either in our office or work-from-home) and requires the ability to work on a computer, operate standard office equipment, and work at a desk. If you need reasonable accommodation for any part of the employment process due to a physical or mental disability, please send an email to [email protected] with the subject "Accommodation". Reasonable accommodation requests will be considered on a case-by-case basis. Benefits for You Health, Dental, and Vision insurance with 100% employee premium coverage (Starts Day 1) Unlimited PTO Annual Professional Development stipend Annual home office stipend 401K Match (after 90 days) Equal Opportunity Employer Codoxo provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment.