Payment Integrity Analyst Lead

Monument Health•Rapid City, SD

1d•$26 - $33

About The Position

The Payment Integrity Analyst Lead is responsible for oversight of KPI, education and workflows associated with the monitoring and recovery of variances between expected and actual reimbursement from payers. This team member will serve as a content expert within the team, assisting with the creation, implementation and maintenance of training and departmental policies, procedures, and onboarding. This role will also serve as the liaison between department and payer representatives for escalated issue resolution. 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 Flexible scheduling

Requirements

Education - High School Diploma/ GED
Experience - 2+ years EPIC finance experience

Nice To Haves

Education - Bachelors degree in healthcare management

Responsibilities

Use reporting to identify and track qualified claims for reimbursement corrections from payer to ensure all affected claims are paid appropriately as identified
Function as liaison between department and payer representatives for escalated issue resolution
Assist with creation, implementation, and maintenance of training and departmental policies and procedures
Utilize reporting to identify and evaluate payer trends
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 super user for implementation of payer contract loading in EPIC and contract modeling systems.
All other duties as assigned.