Payment Integrity Analyst

Monument Health•Rapid City, SD

1d•$24 - $31•Onsite

About The Position

The Payment Integrity Analyst monitors and recovers variances between expected and actual payer reimbursement and accurately compiles information needed to defend expected reimbursement. The role uses reporting, payer contracts, fee schedules, EOBs, payer policies, and patient benefit information to identify and address payment variances and initiate appeals. Knowledge of payer contracts and the appeal process is preferred. The analyst works with internal and external leaders and with departments responsible for payment root causes to communicate variances, trend issues, and support preventable-underpayment efforts. The role also supports implementation of payer contract loading in EPIC and contract modeling systems. This position is in Monument Health’s CS Managed Care department, within Revenue Cycle/Revenue Integrity, and is based in Rapid City, South Dakota. The scheduled workweek is 40 hours; assigned schedules and hours are determined by the department.

Requirements

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

Nice To Haves

Bachelor’s degree in healthcare management.
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 appeal process.

Responsibilities

Use extensive reporting to facilitate prompt identification of insurance variances.
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.
Evaluate and identify insurance underpayments and payment variances, including zero payments, full denials, and line-item denials; determine root causes and take necessary actions to recover underpayments.
Assign and distribute underpayment inventory to analysts to contact insurance carriers, gather and compare pricing information using EOBs, contracts, payer policies, and patient benefits, and initiate appeals.
Work with internal and external leaders to communicate payer variances and reimbursement recovery.
Apply knowledge of reimbursement methodologies used in healthcare payments.
Work with departments responsible for root causes to trend issues and provide feedback aimed at preventing underpayments.
Serve as a support super user for implementation of payer contract loading in EPIC and contract modeling systems.
Perform other duties as assigned.