Payment Integrity Business Analyst

Codoxo is a leading provider of AI-driven solutions aimed at reducing waste, fraud, and abuse in healthcare. The Payment Integrity Business Analyst will support the implementation and optimization of Codoxo’s Payment Integrity SaaS solutions, acting as a bridge between customer success teams and product management to enhance client engagement and operational workflows.

Responsibilities:

• 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
• 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
• 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
• 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

Requirements:

• 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
• 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
• Proficient in Microsoft Office Suite
• Experience with data analytics tools or SQL-based environments preferred
• Familiarity with Confluence, Jira, SharePoint, and AWS is desirable