Payment Integrity Analyst

Inova Health; United States; Hybrid; USD 85,000 - 110,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Retirement 5% match

Tuition and student loan assistance

Mental health support sessions

Paid time off and parental leave

Flexible schedules and remote/hybrid机会

Job summary

Inova Health is seeking a dedicated Payment Integrity professional to join our team. This full-time, hybrid role requires working Monday through Friday with location options across VA, MD, DC, DE, FL, GA, NC, OH, PA, SC, TN, TX, WV.

The ideal candidate will have 6 years of experience in payment integrity or denials management, with a strong background in analytics, reimbursement policies, and collaboration with operational leadership.

Qualifications

• 6 years of experience in Payment Integrity, Denials Management, or similar roles.
• Associate's degree in Finance, Business Administration, Healthcare Management or related field, or HS Diploma/GED with 2+ years relevant experience.

Responsibilities

• Validate reimbursement accuracy against payor agreements, fee schedules and payment policies.
• Analyze claims, remittances, contractual allowances and payment activity for variances.
• Investigate reimbursement issues due to contract misapplication, processing errors or policy changes.
• Monitor reimbursement trends and escalate recurring issues to leadership.
• Conduct reviews of claims, remittances, refunds and recoupments to identify overpayment recovery opportunities.
• Identify root causes of overpayments and recommend corrective actions.
• Perform root cause analyses to identify drivers of payment discrepancies, denials and risks.
• Translate reimbursement findings into actionable recommendations for operations and leadership.
• Support initiatives related to revenue protection and payment accuracy improvement.

Skills

Root cause analysis

Critical thinking

Verbal communication

Problem solving

Proactive work ethic

Education

Associate's degree in Finance/Business/Healthcare

HS Diploma or GED with experience

Tools

Excel (formulas)

Pivot tables

Epic reporting (SlicerDicer)

Job description

Inova is looking for a dedicated Payment Integrity to join the team. This role is full-time Monday through Friday hybrid.

Must be located in these states to work remote - VA, MD, DC, DE, FL, GA, NC, OH, PA, SC, TN, TX, WV.

Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation.

Featured Benefits:

• Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program.
• Retirement: Inova matches the first 5% of eligible contributions - starting on your first day.
• Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans.
• Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.
• Work/Life Balance: offering paid time off, paid parental leave, flexible work schedules, and remote and hybrid career opportunities

Job Responsibilities:

• Validates reimbursement accuracy against payor agreements, fee schedules, reimbursement methodologies, and payment policies.
• Analyzes claims, remittances, contractual allowances, and payment activity to identify payment variances and systemic discrepancies.
• Investigates reimbursement issues related to contract misapplication, processing errors, coding discrepancies, authorization requirements, or policy changes.
• Monitors reimbursement trends and elevate recurring issues requiring operational, contractual, or payor intervention.
• Conducts detailed reviews of claims, remittances, refunds, and recoupments to identify overpayment recovery opportunities.
• Determines root causes of overpayments and recommends corrective actions to prevent recurrence.
• Conducts root cause analyses to identify drivers of payment discrepancies, denials, and reimbursement risks.
• Translates complex reimbursement findings into actionable recommendations for operational teams and leadership.
• Supports strategic initiatives related to revenue protection, reimbursement optimization, and payment accuracy improvement.
• May perform additional duties as assigned.

Additional Requirements:

• Experience - 6 years of experience in Payment Integrity, Denials Management, or similar roles.
• Education - Associate's degree in Finance, Business Administration, Healthcare Management or related field; or HS Diploma/GED and 2 years of relevant professional experience in addition to the minimum Experience requirement

Preferred Qualifications:

• 3+ years of hospital billing experience in: Underpayments or
• Overpayments or
• Denials
• Excel skills preferred, including basic formulas
• Root cause analysis and critical thinking skills
• Strong verbal communication and articulation skills
• Problem-solving ability
• Proactive work ethic
• Preferred experience with Epic HB Experience using SlicerDicer & other Epic reporting features
• Advanced Excel skills, including pivot tables
• Experience producing executive-level analytic summaries
• Quality assurance (QA) experience