Payment Integrity Analyst

Monument Health Rapid City Hospital•Rapid City, SD

About The Position

The Payment Integrity Analyst monitors and recovers variances between expected and actual payer reimbursement and compiles information needed to support expected reimbursement. The role uses reporting to identify insurance variances, verifies payments against contract terms and fee schedules, analyzes payer contracts and pricing, and identifies and investigates underpayments. The analyst determines root causes and takes appropriate steps to recover underpayments, including gathering and comparing payment, contract, payer-policy, and patient-benefit information to initiate appeals. The position also communicates payer variances and recovery progress with internal and external leaders, works with departments to prevent recurring underpayments, and supports payer contract loading in EPIC and contract modeling systems. This is a regular position in Monument Health’s Revenue Cycle/Revenue Integrity organization, based in Rapid City, South Dakota. The schedule is 40 hours per week, with assigned schedules and hours determined by the department. The listed starting pay range is $24.43–$30.54, determined by the applicant’s knowledge, skills, and experience.

Requirements

High school diploma or GED.
Ability to work assigned schedules and hours as determined by the department.

Nice To Haves

Bachelor’s degree.
At least 1 year of hospital or professional billing experience.
At least 1 year of EPIC revenue cycle experience.
Knowledge of payer contracts and the appeals process.

Responsibilities

Use extensive reporting to identify insurance variances promptly.
Verify insurance payments for accuracy and compliance with contract terms and fee schedules.
Analyze client and payer contracts to validate pricing accuracy and consistency in the contract management system.
Identify underpayments and payment variances, including zero payments, full denials, and line-item denials; determine root causes and take action to recover underpayments.
Assign and distribute underpayment inventory to analysts for contacting insurance carriers, gathering and comparing pricing information, and initiating appeals.
Communicate payer variances and reimbursement recovery with internal and external leaders.
Apply knowledge of reimbursement methodologies used in healthcare payments.
Work with departments responsible for root causes to trend issues and provide feedback intended to prevent underpayments.
Support implementation of payer contract loading in EPIC and contract modeling systems.
Perform other duties as assigned.