Position Description: Senior Analyst, Edits 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.

The successful candidate will be responsible for designing, implementing, and managing edits that prevent inappropriate, inaccurate, or wasteful payments. This role will contribute to the full lifecycle of edit development-from opportunity identification to rules design, clinical validation, user acceptance testing, deployment, monitoring, and optimization.

The adecuado candidate has strong claims domain expertise, analytic skills, and a deep understanding of coding, billing, medical policy, and payment integrity concepts. This role must be performed from the CGI Office in Bogota, Colombia.

Key Responsibilities1. 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

2. 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

3. 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

4.

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

5. Governance &

• Documentation

- Maintain edit specifications, business rules, and performance logs
- Ensure each edit has testing artifacts
- Ensure compliance with regulatory and audit requirements (CMS/State)

Education Bachelor's degree in business, healthcare, data analytics, public health, or related field or equivalent experience

Required Qualifications

- 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

Preferred Qualifications

- SQL skills a plus
- Clinical licensure: RN
- Experience with claims rules platforms a plus (Optum/CES, Cotiviti, McKesson, internal rules engines)
- Creating Professional and Outpatient Edits/Concepts

Competencies

- Analytical & critical thinking
- Strong written communication
- Policy & regulatory fluency
- Project management & prioritization
- Ability to work cross-functionally
- High attention to detail

Locations Senior Payment Integrity Analyst - Claims Editing

Category: Business Analysis (functional and technical)

Main location: Colombia, Bogota

Position ID: J1026-1980

Employment Type: Full Time

📌 Senior Payment Integrity Analyst Claims Editing (Colombia)
🏢 CGI Group
📍 Colombia