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

About this Role

The Senior Payment Integrity Analyst plays a critical role in ensuring the accuracy and compliance of financial transactions within the Medicare Prescription Payment Plan. This position involves overseeing and performing advanced analysis of payment and invoicing data, identifying discrepancies, and leading initiatives to enhance payment integrity processes. The Senior Payment Integrity Analyst will work closely with cross-functional teams, including finance, compliance, and product team, to ensure the effective management of payments and adherence to Medicare regulations.

Position Responsibilities:

• Conduct complex analyses of payment and invoicing data to identify trends, discrepancies, and potential issues.
• Lead reconciliation efforts for large-scale payment processes, ensuring accuracy and compliance with Medicare regulations.
• Develop and implement reconciliation reports and processes to streamline payment accuracy and integrity.
• Identify and recommend process improvements to enhance payment accuracy and efficiency.
• Collaborate with product team and other departments to develop and refine automated solutions for payment processing.
• Prepare detailed reports on payment integrity, including findings, recommendations, and corrective actions.
• Maintain comprehensive documentation of reconciliation activities, discrepancies, and resolutions.
• Other duties as assigned.
• Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance.

Required Qualifications:

• 5+ years of experience in payment integrity, finance, or accounting, with a focus on Medicare or healthcare payment transactions.
• 1+ years of fintech experience (financial transaction software).
• Strong analytical skills and experience with financial reconciliation and reporting.
• In-depth knowledge of Medicare payment processes and regulatory requirements preferred.
• Proficiency in data analysis tools and software (e.g., Excel, SQL).
• Excellent communication, problem-solving, and leadership 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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