Inova is looking for a dedicated Payment Integrity to join the team. This role is full-time Monday through Friday hybrid.
Must be located in these states to work remote - VA, MD, DC, DE, FL, GA, NC, OH, PA, SC, TN, TX, WV.
Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation.
Featured Benefits:
Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program.
Retirement: Inova matches the first 5% of eligible contributions – starting on your first day.
Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans.
Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.
Work/Life Balance: offering paid time off, paid parental leave, flexible work schedules, and remote and hybrid career opportunities
Job Responsibilities:
- Validates reimbursement accuracy against payor agreements, fee schedules, reimbursement methodologies, and payment policies.
- Analyzes claims, remittances, contractual allowances, and payment activity to identify payment variances and systemic discrepancies.
- Investigates reimbursement issues related to contract misapplication, processing errors, coding discrepancies, authorization requirements, or policy changes.
- Monitors reimbursement trends and escalate recurring issues requiring operational, contractual, or payor intervention.
- Conducts detailed reviews of claims, remittances, refunds, and recoupments to identify overpayment recovery opportunities.
- Determines root causes of overpayments and recommends corrective actions to prevent recurrence.
- Conducts root cause analyses to identify drivers of payment discrepancies, denials, and reimbursement risks.
- Translates complex reimbursement findings into actionable recommendations for operational teams and leadership.
- Supports strategic initiatives related to revenue protection, reimbursement optimization, and payment accuracy improvement.
- May perform additional duties as assigned.
Additional Requirements:
- Experience - 6 years of experience in Payment Integrity, Denials Management, or similar roles.
- Education - Associate's degree in Finance, Business Administration, Healthcare Management or related field; or HS Diploma/GED and 2 years of relevant professional experience in addition to the minimum Experience requirement
Preferred Qualifications:
- 3+ years of hospital billing experience in:
- Underpayments or
- Overpayments or
- Denials
- Excel skills preferred, including basic formulas
- Root cause analysis and critical thinking skills
- Strong verbal communication and articulation skills
- Problem-solving ability
- Proactive work ethic
- Preferred experience with Epic HB
- Experience using SlicerDicer & other Epic reporting features
- Advanced Excel skills, including Pivot Tables
- Experience producing executive-level analytic summaries
- Quality assurance (QA) experience
