Payment Integrity Analyst

Location: Remote (For Non-Local) or Hybrid (Local to NYC area)

About this Role

The Payment Integrity Analyst is responsible for analyzing and reconciling payment transactions within the Medicare Prescription Payment Plan to ensure accuracy and compliance with regulatory standards. This position involves performing detailed audits, investigating discrepancies, and assisting in the development of processes to maintain payment integrity.

Position Responsibilities:

• Review and analyze payment transactions and invoices to ensure they are processed accurately and in accordance with Medicare guidelines.
• Assist in reconciling payment discrepancies and resolving issues related to invoicing and payments.
• Prepare and maintain reconciliation reports for review by senior analysts and managers.
• Support the implementation and maintenance of processes and tools for effective payment integrity.
• Collaborate with team members to improve existing procedures and streamline reconciliation efforts.
• Assist in the development of automated solutions for payment processing where applicable.
• Document findings, discrepancies, and resolutions related to payment integrity issues.
• Assist in preparing regular and ad-hoc reports on payment accuracy and integrity.
• Other duties as assigned.
• Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance.

Required Qualifications:

• Bachelor's degree in finance, Accounting, Business Administration, or a related field.
• 1+ years of fintech experience (financial transaction software).
• 2+ years of experience in payment processing, finance, or accounting, preferably with experience in Medicare or healthcare payments.
• Strong analytical skills and attention to detail.
• Knowledge of Medicare payment processes and regulatory requirements is a plus.
• Proficiency in Microsoft Excel and experience with data analysis tools.
• Strong communication and problem-solving skills.

Nothing in this position description restricts management's right to assign or reassign duties and responsibilities to this job at any time.

About Capital Rx

Capital Rx is a full-service pharmacy benefit manager (PBM) and pharmacy benefit administrator (PBA), advancing our nation's electronic healthcare infrastructure to improve drug price visibility and patient outcomes. As a Certified B Corp, Capital Rx is executing its mission through the deployment of JUDI, the company's cloud-native enterprise health platform, and a Single-Ledger Model, which increases visibility and reduces variability in drug prices. JUDI connects every aspect of the pharmacy ecosystem in one efficient, scalable platform, servicing millions of members for Medicare, Medicaid, and commercial plans. Together with its clients, Capital Rx is reimagining the administration of pharmacy benefits and rebuilding trust in healthcare.

Capital Rx values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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