Current Employees:

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Primary Location

Rapid City, SD USA

Department

CS Managed Care

Scheduled Weekly Hours

40

Starting Pay Rate Range

$25.88 - $32.35

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

Job Summary

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 (extra pay for working evening, nights or weekends)

*Flexible scheduling

Job Description

Essential Functions:

• 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.

Additional Requirements

Required:

Education - High School Diploma/ GED

Experience - 2+ years EPIC finance experience

Preferred:

Education - Bachelors degree in healthcare management

Physical Requirements:
Sedentary work - Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time.

Job Category

Revenue Cycle

Job Family

Revenue Integrity

Shift

Employee Type

Regular

15 Corporate Services Division

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.