Payment Integrity Analyst
About The Position
Inova is seeking a dedicated Payment Integrity Analyst to validate reimbursement accuracy and investigate payment discrepancies. This is a full-time, Monday-through-Friday hybrid role. Remote work is available only to candidates located in VA, MD, DC, DE, FL, GA, NC, OH, PA, SC, TN, TX, or WV. The analyst reviews claims, remittances, contractual allowances, and payment activity; investigates issues involving contract application, processing, coding, authorization requirements, and policy changes; and monitors trends for recurring reimbursement problems. The role also reviews claims, refunds, and recoupments to identify overpayment recovery opportunities, determines root causes, and recommends actions to prevent recurrence. The analyst communicates findings and recommendations to operational teams and leadership and supports initiatives that improve revenue protection, reimbursement optimization, and payment accuracy. Additional duties may be assigned.
Requirements
- Six years of experience in Payment Integrity, Denials Management, or similar roles.
- Associate's degree in Finance, Business Administration, Healthcare Management, or a related field; alternatively, a high school diploma or GED and two years of relevant professional experience in addition to the minimum experience requirement.
Nice To Haves
- Three or more years of hospital billing experience in underpayments, overpayments, or denials.
- Excel skills, including basic formulas.
- Root cause analysis and critical thinking skills.
- Strong verbal communication and articulation skills.
- Problem-solving ability.
- Proactive work ethic.
- Experience with Epic HB.
- Experience using SlicerDicer and other Epic reporting features.
- Advanced Excel skills, including Pivot Tables.
- Experience producing executive-level analytic summaries.
- Quality assurance (QA) experience.
Responsibilities
- Validate reimbursement accuracy against payor agreements, fee schedules, reimbursement methodologies, and payment policies.
- Analyze claims, remittances, contractual allowances, and payment activity to identify payment variances and systemic discrepancies.
- Investigate reimbursement issues related to contract misapplication, processing errors, coding discrepancies, authorization requirements, or policy changes.
- Monitor reimbursement trends and escalate recurring issues requiring operational, contractual, or payor intervention.
- Review claims, remittances, refunds, and recoupments to identify overpayment recovery opportunities.
- Determine root causes of overpayments and recommend corrective actions to prevent recurrence.
- Conduct root cause analyses to identify drivers of payment discrepancies, denials, and reimbursement risks.
- Translate complex reimbursement findings into actionable recommendations for operational teams and leadership.
- Support strategic initiatives related to revenue protection, reimbursement optimization, and payment accuracy improvement.
- Perform additional duties as assigned.
Benefits
- Medical, dental, and vision coverage.
- Team member wellness program.
- Inova matches the first 5% of eligible retirement contributions, starting on the first day.
- Up to $5,250 per year in education assistance.
- Up to $10,000 in student loan assistance.
- Mental health coaching or therapy sessions for team members, spouses/partners, and children: 25 sessions per person per year at no cost.
- Paid time off.
- Paid parental leave.
- Flexible work schedules.
- Remote and hybrid career opportunities.
- Professional development opportunities.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
Associate degree
