Payment Integrity Analyst

15 Corporate Services Division; United States; On-site; USD 34,000 - 42,000; Full time

Benefits offered by this job

Supportive work culture

Medical, Vision and Dental Coverage

Retirement Plans, Health Savings and F

Instant pay is available for eligible

Paid Time Off Accrual Bank

Opportunities for growth and advance

Tuition assistance/reimbursement

Excellent pay differentials on certain

Flexible scheduling

Job summary

Monument Health seeks a Payment Integrity Analyst to monitor and recover variances between expected and actual insurance reimbursement. You will verify payments, analyze contracts, and initiate appeals when underpayments are found.

The role requires EPIC revenue cycle experience and collaboration with internal and external stakeholders to defend and optimize payments. We seek candidates with hospital billing experience and a background in healthcare management.

Qualifications

• 1+ years of hospital or professional billing experience.
• 1+ years of EPIC revenue cycle experience.
• Preferred: Bachelor's degree in healthcare management.

Responsibilities

• Monitor and recover variances between expected and actual reimbursement.
• Compile information required to defend expected reimbursement.
• Identify underpayments and initiate appropriate appeals with payers.
• Coordinate with internal teams to address root causes of variances.
• Support implementation of payer contracts and EPIC revenue cycle processes.

Education

High School Diploma/ GED

Bachelors degree in healthcare management

Job description

Payment Integrity Analyst

Primary Location Rapid City, SD USA Department CS Managed Care Scheduled Weekly Hours 40 Starting Pay Rate Range $24.43 - $30.54 (Determined by the knowledge, skills, and experience of the applicant.)

The Payment Integrity Analyst is accountable for monitoring and recovering variances between expected and actual reimbursement from payers. Accurately compiles information required to defend expected reimbursement. Knowledge of payer contracts and appeal process is preferred.

Monument Health offers competitive wages and benefits on qualifying positions.

• Supportive work culture
• Medical, Vision and Dental Coverage
• Retirement Plans, Health Savings Account, and Flexible Spending Account
• Instant pay is available for qualifying positions
• Paid Time Off Accrual Bank
• Opportunities for growth and advancement
• Tuition assistance/reimbursement
• Excellent pay differentials on qualifying positions
• Flexible scheduling

Job Description

Utilize extensive reporting to facilitate prompt identification of insurance variances. Verify insurance payments for accuracy and compliance with contract terms and fee schedules. Analyze multiple Client/Payer Contracts to validate pricing accuracy and consistency within contract management system. Evaluate and identify insurance underpayments and payment variances from zero payments, full denials, and line-item denials, determine root cause of underpayments and take necessary actions to recover insurance underpayments. Strategically assign and distribute underpayment inventory to individual Analysts to call insurance carrier, gather and compare pricing information via EOBs, contracts, payor policies, patient benefits to effectively initiate appeals. Works effectively with internal and external leaders to effectively communicate payer variances and reimbursement recovery. Understands a wide variety of reimbursement methodology used in health care payments. Works closely with each department responsible for root causes to trend issues and provide feedback that will result in preventable underpayments. Functions as a support super user for implementation of payer contract loading in EPIC and contract modeling systems. Other duties as assigned.

Additional Requirements

Education - High School Diploma/ GED

Preferred: Education - Bachelors degree in healthcare management

Experience - 1+ years of hospital or professional billing experience, 1+ years of EPIC revenue cycle experience

Physical Requirements

Sedentary work - Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time.

Job Category Revenue Cycle

Job Family Revenue Integrity

Shift Requires the ability to work assigned schedules and hours as determined by the department

Employee Type Regular 15 Corporate Services Division Make a difference. Every day.

Monument Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected Veteran status.