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Starting Pay Rate Range
$23.60 - $29.50(Determined by the knowledge, skills, and experience of the applicant.)
Job Summary
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. Some of those benefits can include:
*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 (extra pay for working evening, nights or weekends)
*Flexible scheduling
Job Description
Essential Functions:
- 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
Required:
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 CycleJob Family
Revenue IntegrityDepartment
CS Managed CareScheduled Weekly Hours
40Shift
Employee Type
Regular15 Corporate Services Division
Make a difference. Every day.
MonumentHealthis 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.
Regional 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.