[Skip to main content](#main-content) [ OpenNash ](https://opennash.com/) / [Jobs](https://jobs.opennash.com/) [ 01 Search jobs](https://jobs.opennash.com/search/)[ 02 Companies](https://jobs.opennash.com/explore/)[ 03 Hiring report](https://jobs.opennash.com/reports/hiring/)[ 04 AI assistants](https://jobs.opennash.com/connect/)[ 05 How it works](https://jobs.opennash.com/methodology/) Molina Healthcare · United States # Business Analyst- Payment Integrity/Claims & Coding (REMOTE) United States Remote Full-time Operations Listed on Molina Healthcare’s official careers site. Posted November 7, 2026. Check that it is still open and apply there. [Apply on Molina Healthcare’s careers site →](https://hckd.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_1/job/2039097) [OpenNash Jobs](https://jobs.opennash.com/) / [Molina Healthcare](https://jobs.opennash.com/companies/molina-healthcare/) / Business Analyst- Payment Integrity/Claims & Coding (REMOTE) ## 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. ### 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. ## At a glance - Posted by the employer: Nov 7, 2026 - First seen by OpenNash: Nov 8, 2026 - Last checked: Nov 8, 2026 - Listed for: 1 day - Location: United States - Work arrangement: Remote - Employment type: Full-time[Apply on Molina Healthcare’s careers site →](https://hckd.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_1/job/2039097) ## Hiring at Molina Healthcare - Open jobs: 455 - New in the last 7 days: After two weekly collections - Tracked since: Jul 10, 2026 [All Molina Healthcare jobs](https://jobs.opennash.com/companies/molina-healthcare/) · [Weekly hiring report](/reports/hiring/) ## More jobs at Molina Healthcare ### [Care Manager (BH Licensed)](https://jobs.opennash.com/companies/molina-healthcare/jobs/90b19be8371bbff005a8/) United States ### [Care Manager (RN)](https://jobs.opennash.com/companies/molina-healthcare/jobs/6251f2ac4ee956487c31/) United States ### [Care Review Clinician (BH Licensed)](https://jobs.opennash.com/companies/molina-healthcare/jobs/f2d3b1f63156fb5fc489/) United States ### [Care Review Clinician (RN)](https://jobs.opennash.com/companies/molina-healthcare/jobs/47581ca0fbbb43c4f10f/) United States ## Similar jobs at other companies ### [Senior Payment Integrity Program Consultant, Claims Recovery](https://jobs.opennash.com/companies/centene/jobs/d23df1b06bcba773c5ea/) Centene · Remote-MO ### [Senior Manager, Payment Integrity COE](https://jobs.opennash.com/companies/cvs-health/jobs/63bcbe6d94222868b206/) CVS Health · Hartford, CT ### [Payment Integrity Specialist – Strategic Initiatives](https://jobs.opennash.com/companies/centene/jobs/2e4b2c6b6e4a6d114fd6/) Centene · Remote-MO +5 more ### [Medical Director-Payment Integrity](https://jobs.opennash.com/companies/humana/jobs/ba060bd3b62ba25a689c/) Humana · Remote, Nationwide, United States of America ### [Senior Product Manager - Fraud and Abuse Detection - Payment Integrity - Remote](https://jobs.opennash.com/companies/unitedhealth-group/jobs/ce802a823bf7bffb2ef3/) UnitedHealth Group · Eden Prairie, Minnesota [Operations jobs](/functions/operations/) OpenNash lists jobs from employers’ own careers sites and does not handle applications. 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