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Payment Integrity Analyst Lead | Managed Care

Monument Health
flexible benefit account, paid time off
United States, South Dakota, Rapid City
677 Cathedral Drive (Show on map)
May 12, 2025
Current Employees: If you are a current employee, please apply via the internal career site by logging into your Workday Account and clicking the "Career"icon on your homepage. 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. MonumentHealthis 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.