Payment Integrity Analyst

Current Employees:

(Determined by the knowledge, skills, and experience of the applicant.)

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

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.

Required:

Education - High School Diploma/ GED

Requires the ability to work assigned schedules and hours as determined by the department

Make a difference.  Every day.

Monument 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.