Full time 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.
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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
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
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
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