Position Description
Join CGI
CGI is seeking a results-oriented Senior Analyst to join our growing edits team. This role will be responsible for expansively growing CGI’s edits library and driving value through the identification and prevention of improper payments.
Requirements:
• Bachelor’s degree in Computer Science, Engineering, or a related field (or equivalent practical experience).
• Conversational English level B2 or higher.
• 5+ years of experience in payment integrity, claims analytics, medical policy, or coding
• Strong knowledge of CPT/HCPCS, ICD-10, DRG, APC/OPPS, NCCI bundling policies
• Coding certifications: CPC, CCS, COC, CPMA, RHIA, RHIT
• Experience in prepay editing or post-pay audit logic
Responsibilities:
• Edit Development & Implementation
• Identify high-impact edit opportunities using claim data analysis
• Translate medical policy, CMS rules, coding guidance, and industry best practices into actionable edit logic
• Create rule specifications (conditions, exclusions, thresholds, flags)
• Design validation datasets and perform pre-deployment testing
• Edit Monitoring & Optimization
• Track edit performance, yield, false positives, provider abrasion, and ROI
• Continuously refine edits based on results, coding updates, and provider behavior
• Maintain inventory of active edits with documentation and version control
• Identify obsolete or low-value edits and retire/update accordingly
• Clinical & Coding Alignment
• Collaborate with Medical Directors for clinical validation
• Ensure edits comply with CMS coding policies, NCCI, LCD/NCD rules
• Work with internal auditors (RN/coding) to validate appropriateness
• Cross-Functional Collaboration
• Partner with SIU, coding, claims operations, and policy.
• Communicate edit design and rationale to leadership
• Work with provider relations to address provider questions or disputes
• Provide reporting and dashboards for edit outcomes
• Governance & Documentation
• Maintain edit specifications, busi
📌 Senior Analyst, Edits (Bogotá)
🏢 CGI
📍 Bogotá