Payment Integrity Revenue Analyst II

HMA is the premier third-party health plan administrator across the PNW and beyond. We relentlessly deliver on our promise to provide medium to large-size employers with customized health plans. We offer various high-quality, affordable healthcare plan options supported with best-in-class customer service. 

We are proud to say that for three years, HMA has been chosen as a ‘Washington’s Best Workplaces’ by our Staff and PSBJ™. Our vision, ‘Proving What’s Possible in Healthcare™,’ and our values, People First!, Be Extraordinary, Work Courageously, Own It, and Win Together, shape our culture, influence our decisions, and drive our results.

What we are looking for: We are always searching for unique people to add to our team. We only hire people that care deeply about others, thrive in evolving environments, gain satisfaction from being part of a team, are motivated by tackling complex challenges, are courageous enough to share ideas, action-oriented, resilient, and results-driven. 

What you can expect: You can expect an inclusive, flexible, and fun culture, comprehensive salary, pay transparency, benefits, and time off package with plenty of personal development and growth opportunities. If you are looking for meaningful work, a clear purpose, high standards, work/life balance, and the ability to contribute to something important, find out more about us at: https://www.accesshma.com/

How YOU will make a Difference:

The Payment Integrity Revenue Analyst contributes to HMA’s financial and operational success by ensuring accurate and efficient revenue charges and vendor payments. This role is responsible for monitoring revenue streams and processes, validating revenue accuracy, ensuring accurate fee payments to vendors, and identifying and resolving sources of inaccurate revenue charges. The analyst will collaborate with cross‑functional teams to resolve system and process issues and to deliver impactful process improvements. The development of effective reports, dashboards, and documentation are essential for success in this position. As role levels progress, analysts will handle increasingly complex requirements and investigations and help lead in the evolution of a high quality, robust revenue integrity program.

What YOU will do:

• Be the Subject Matter Expert on PI revenue processes, resources, and expectations.
• Independently analyze complex payment data sets to identify trends, anomalies, and systemic variances.
• Build enhanced dashboards, KPI scorecards, and analytic models for leadership and client reporting.
• Conduct detailed root‑cause analysis on recurring or high‑impact discrepancies and drive corrective action plans.
• Evaluate the financial impact of payment integrity initiatives and proactively identify new savings opportunities.
• Partner with teams including Claims, clinical cost containment, Finance, and IT to resolve multi‑step or cross‑system issues.
• Identify opportunities to streamline or automate workflow and contribute to SOP development.
• Calculate financial impacts of program changes, such as different revenue structures or vendor change
• Support vendor management including leading vendor-initiated audits.
• Mentor Level I analysts and provide quality reviews of their work.
• Review payment integrity savings and revenue-related reporting by other teams and ensure accuracy in their report content.
• Participate in the design, testing, and implementation of new system edits, automation processes, and audit rules.

Requirements

Knowledge, Experience and Attributes:

• Bachelor’s degree in Finance, Healthcare Administration, Business, or related field (or equivalent experience) preferred.
• 3-5+ years in payment integrity, financial analysis, claims auditing, or healthcare billing.
• Preferred Certifications: CCS, CPC, CPMA, AHIMA.
• Demonstrated experience analyzing claims data and identifying systemic payment issues.
• Working knowledge of coding standards (CPT, HCPCS, ICD‑10), NCCI edits, and reimbursement methodologies (ex. RBRVS, DRG, APC).
• Experience with BI tools (Power BI, Tableau, Qlik) or intermediate SQL preferred.
• Prior experience in a TPA or self‑funded plan environment strongly preferred.
• Ability to independently analyze complex data sets and identify trends, patterns, and root causes.
• Intermediate to advanced Excel skills (VLOOKUP/XLOOKUP, pivot tables, conditional logic).
• Strong understanding of standard claims adjudication logic.
• Ability to draft and refine SOPs, workflows, and business requirements.
• Strong communication skills, including the ability to explain findings to non‑technical audie