Molina Healthcare logo

Business Analyst- Payment Integrity/Claims & Coding (REMOTE)

Molina Healthcare

Remote · USJob$45–97K/yrSeen todaySeen in employer's feed today

Most applications go out cold — see where you stand first. No sign-up to start.

You apply on the employer's site, with no Olive account needed.

Watch jobs like this.

Don't just apply. Show up ready.

Olive works from this exact posting.

At a glance

Compensation
$45–97K/yr
Location
Remote · US
Work Authorization
Not specified

Olive lists jobs from US employers, including remote roles you can work from the United States.

Job overview

This position supports Payment Integrity by researching and developing post-pay recovery concepts and claims edits. It analyzes healthcare claims, billing and coding requirements, and reimbursement policies to identify potential overpayments, then translates findings into business requirements for technical implementation. The role also interprets applicable government and payer guidance to support defensible claims-recovery logic.

Skills & qualifications

RequiredNice to have

Skills

Healthcare ClaimsMedical BillingReimbursement MethodologiesCPTHCPCSICD-10Revenue CodesModifiersClaim TypesPolicy ResearchClaims LogicClaims Data AnalysisPolicy and Legislative ReviewAnalytical SkillsProblem-SolvingMicrosoft Office SuiteWordExcelOutlookTeamsHealthcare Claims ExperienceMedical CodingClaims AuditingPayment IntegrityPost-Pay Claims RecoveryClaims Edit DevelopmentPayment Policy DevelopmentReimbursement RulesCMS GuidanceNCCI GuidanceMedicare GuidanceMedicaid Guidance

Qualifications

2+ Years Relevant ExperienceManaged Care or Health Insurance ExperienceCPC or CCS or COC Certification

Full job description

JOB DESCRIPTION

Job Summary

This position supports Payment Integrity through the research and development of post-pay recovery concepts and claims edits. The role analyzes healthcare claims, medical billing and coding requirements, and reimbursement policies to identify potential overpayment opportunities and translate findings into clearly defined business requirements for technical implementation.

JOB DUTIES

  • Researches and develops post-pay Payment Integrity recovery concepts and claims edits by evaluating healthcare claims, reimbursement patterns, medical billing and coding requirements, and applicable regulatory and payer guidance.

  • Researches and interprets CMS, NCCI, state Medicaid, Medicare, and other applicable reimbursement and coding requirements to support development of defensible claims-recovery logic.

  • Translates identified Payment Integrity opportunities into detailed business requirements, including claim logic, coding criteria, inclusions, exclusions, and supporting documentation for analytic and technical development teams.

KNOWLEDGE/SKILLS/ABILITIES

  • Working knowledge of healthcare claims, medical billing, reimbursement methodologies, and coding systems including CPT, HCPCS, ICD-10, revenue codes, modifiers, and claim types.

  • Ability to research reimbursement and coding policies and translate policy requirements into actionable claims logic and business requirements.

  • Ability to analyze claims data to identify billing patterns, potential overpayments, and opportunities for Payment Integrity recovery concepts.

JOB QUALIFICATIONS

Required Qualifications

  • At least 2 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience.

  • Policy/government legislative review knowledge.

  • Strong analytical and problem-solving skills.

  • Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams.

  • Previous success in a dynamic and autonomous work environment.

Preferred Qualifications

  • Experience working with healthcare claims, medical billing/coding, reimbursement, payment integrity, claims auditing, or an equivalent claims-focused function.

  • Payment Integrity or post-pay claims recovery experience.

  • Experience developing or supporting claims edits, payment policies, recovery concepts, or reimbursement rules.

  • Experience with CMS, NCCI, Medicare, Medicaid, and/or state-specific reimbursement guidance.

  • Medical coding certification such as CPC, CCS, COC, or equivalent.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $44,936.59 - $97,362.61 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

How this job compares

Set against the 5,816 open Business Analyst jobs on Olive Jobs, counted November 9, 2026.

Pay
  • This posting$45–97K/yr
  • US median$89–146K/yr3,951 salary ranges

This range's midpoint, $71K, is 40% below the US median midpoint ($119K) — in the lowest quarter of Business Analyst salary ranges across the US.

Openings
Olive Jobs lists 5,816 open Business Analyst jobs across the US. 8% of them nationwide are listed as remote or flexible.
Hiring the most across the US
Experience
This posting asks for at least 2 years of experience — less than three in four Business Analyst postings that state a minimum ask for (median 4 years, across 4,582 postings).
Education
2,367 of the 5,816 open Business Analyst jobs (41%) ask for a bachelor's degree or higher.

Counted across the open, public US postings on Olive Jobs on November 9, 2026. Pay medians are the middle values of the low ends and of the high ends of postings that list both ends of a range in the same cadence (a yearly salary or an hourly rate); a range's midpoint is halfway between its ends. Pay and experience figures resting on fewer than 20 postings are left out.

Prepare for this role

You've read the whole posting — now see how you match it.