Integrity Analyst

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.

• 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 escalates recurring issues requiring operational, contractual, or payor intervention.
• Conducts detailed reviews of claims, remittances, refunds, and recoupments to identify over payment recovery opportunities.
• Determines root causes of over payments 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.

• 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
  • Over payments 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 Slicer Dicer & other Epic reporting features
• Advanced Excel skills, including Pivot Tables
• Experience producing executive-level analytic summaries
• Quality assurance (QA) experience