Payment Integrity Analyst

The Payment Integrity Analyst is responsible for monitoring and recovering variances between expected and actual reimbursement from payers. This role compiles supporting information to defend expected reimbursement and works with payer contracts, reimbursement methodologies, and the appeals process.

Key responsibilities

• Monitor insurance variances through reporting and analysis
• Verify insurance payments for accuracy and compliance with contract terms and fee schedules
• Review client and payer contracts to validate pricing accuracy and consistency
• Identify underpayments, zero payments, full denials, and line-item denials, then determine root cause and recovery actions
• Assign and manage underpayment inventory to support payer calls, pricing comparisons, and appeals
• Communicate payer variances and reimbursement recovery updates with internal and external stakeholders
• Work with departments responsible for root causes to identify trends and reduce future underpayments
• Support implementation of payer contract loading in EPIC and contract modeling systems
• Perform other duties as assigned