Note: The job is a remote job and is open to candidates in USA. Inova Health is a nonprofit healthcare provider seeking a Payment Integrity Analyst to support accurate reimbursement and revenue protection. The role validates payments, analyzes claims and reimbursement discrepancies, investigates overpayments and denials, performs root cause analysis, and recommends corrective actions and operational improvements.
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
Skills
- Must be located in these states to work remote - VA, MD, DC, DE, FL, GA, NC, OH, PA, SC, TN, TX, WV
- * 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
Benefits
- Medical, dental and vision coverage
- A robust team member wellness program
- Inova matches the first 5% of eligible contributions – starting on your first day
- Up to $5,250 per year in education assistance
- Up to $10,000 for student loans
- 25 mental health coaching or therapy sessions, per person, per year, at no cost, for all Inova team members, their spouses/partners, and their children
- Paid time off
- Paid parental leave
- Flexible work schedules
- Remote and hybrid career opportunities
- Professional development opportunities
Company Overview
Company H1B Sponsorship