Manager Payment Integrity

Current Employees:

If you are a current Monument Health employee, please apply via the internal career site by logging into your Workday Account and clicking the "Career" icon on your homepage.

Primary Work Location

Health Sciences Building

Department

CS Managed Care

Scheduled Weekly Hours

40

Job Summary

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

Job Description

Essential Functions:

• 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.

Additional Requirements

Required

Education - High School Diploma/GED Equivalent

Preferred:

Education - Bachelor's degree in Healthcare Administration

Physical Requirements:
Sedentary work - Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time.

Job Category

Revenue Cycle

Job Family

Revenue Integrity

Shift

Requires the ability to work assigned schedules and hours as determined by the department

Employee Type

Regular

15 Corporate Services Division

Make a difference.  Every day.

Monument Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected Veteran status.