CGI · 2 days ago
Senior Analyst, Edits | Payment Integrity (Remote)
United States
Full-time
Remote
Mid, Senior Level
$75K/yr - $100K/yr
5+ years expCGI is seeking a results-oriented Senior Analyst to join their growing Edits team. In this pivotal role, you will manage the full lifecycle of edit development, driving measurable value by identifying and preventing improper payments across the healthcare landscape.
AnalyticsApplication Performance ManagementBusiness IntelligenceConsultingCyber SecurityFinanceInformation TechnologyTechnical Support
Responsibilities
Identify Opportunities: Use claim data analysis to pinpoint high-impact edit opportunities
Translate Policy: Convert medical policy, CMS rules, and coding guidance into actionable logic
Technical Design: Create detailed rule specifications, including conditions, exclusions, thresholds, and flags
Validation: Design validation datasets and lead rigorous pre-deployment user acceptance testing (UAT)
Performance Tracking: Monitor yield, false positives, ROI, and provider abrasion
Continuous Improvement: Refine edits based on real-world results, coding updates, and provider behavior
Lifecycle Management: Maintain a documented inventory of active edits and retire obsolete or low-value rules
Validation: Partner with Medical Directors and internal auditors (RNs/Coders) to ensure clinical appropriateness
Compliance: Ensure all edits strictly comply with CMS coding policies, NCCI, and LCD/NCD rules
Stakeholder Engagement: Partner with SIU, claims operations, and policy teams to align on strategy
Communication: Present edit design rationale and performance dashboards to leadership
Qualification
Required
Active coding certification (CCS or CPC) with deep clinical coding expertise
5+ years in payment integrity, claims analytics, medical policy, or coding
Deep expertise in CPT/HCPCS, ICD-10, DRG, APC/OPPS, and NCCI bundling policies
Proven experience in prepay editing or post-pay audit logic
Bachelor's degree in Business, Healthcare, Data Analytics, Public Health, or a related field (or equivalent experience)
Preferred
Proficiency in SQL and experience with claims rules platforms (e.g., Optum/CES, Cotiviti, McKesson)
Current RN licensure
Benefits
Competitive compensation
Comprehensive insurance options
Matching contributions through the 401(k) plan and the share purchase plan
Paid time off for vacation, holidays, and sick time
Paid parental leave
Learning opportunities and tuition assistance
Wellness and Well-being programs
Company
CGI
CGI is an IT and business consulting services firm that offers consulting, cyber security, cloud, and IT services.
10001+ employees
H1B Sponsorship
CGI has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (775)
2024 (762)
2023 (795)
2022 (940)
2021 (846)
2020 (582)
Funding
Current Stage
Public CompanyTotal Funding
$1.2B2025-03-12Post Ipo Debt· $650M
2024-09-03Post Ipo Debt· $550.87M
1998-10-06IPO
Leadership Team
François Boulanger
President and Chief Executive Officer at CGI
Raymond McMann
VP, Global Oil & Gas Industry
Recent News
2026-01-22
Digital Journal
2026-01-22
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