Manager Payment Integrity

Monument Health•Rapid City, SD

About The Position

The Manager of Payment Integrity reports to the Director and will have extensive knowledge of revenue cycle, provider enrollment, provider authorization and payor medical and reimbursement policies. Manages account level oversight to include inventory management, trending analysis, high dollar claims escalation and quality review. Is responsible for root cause analysis of payment variances. Works closely with Director to implement process enhancements to ensure positive resolution of future claims. Demonstrates ongoing growth and development of self through active self-reflection, personal competency development strategies, and role modeling the “Grow myself, grow my team, and grow Monument Health (G3) Leadership Competencies” to promote our Monument Health vision and mission. 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

Requirements

High School Diploma/GED Equivalent
Requires the ability to work assigned schedules and hours as determined by the department

Nice To Haves

Education - Bachelor's degree in Healthcare Administration

Responsibilities

Utilize extensive reporting to facilitate prompt identification of insurance variances.
Responsible for preparing and analyzing, inpatient, outpatient, professional and ancillary services for contract modeling.
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.
Develops and maintains business relationships with payors for the purposes of contract negotiations.
Verification and accuracy of data, compiling data and translating data into usable information to report to CFO, finance department, revenue cycle and other key stakeholders.
All other duties as assigned.