The Payment Validation Analyst works under the supervision of the Director of Revenue Integrity and is responsible for ensuring accurate payment is received from payors, including line-level payment validation when appropriate.
Key responsibilities include:
- Analyze contractual underpayments and resolve daily Epic work queue items related to underpayments.
- Investigate price and contract discrepancies and work with Revenue Integrity and CDM teams on corrective actions.
- Participate in rebill projects focused on recovering underpayments.
- Serve as a subject matter expert on payer reimbursements and contracts.
- Research non-covered or denied charges and assist with appeals.
- Identify coding, charging, and billing issues that contribute to inaccurate payment and help educate staff on resolutions.
- Prepare monthly measurement reports using Epic data and submit findings and recommendations for approval.
- Create and maintain contracts in Epic.
- Support new program start-up efforts and identify reimbursable services not being coded or charged.
- Research CPT, revenue code, and charge master issues referred by Patient Financial Services, Coding, or Revenue Integrity.
- Coordinate routine projects and organize project steps with minimal direction.
Requirements & Qualifications
- Bachelor's degree required.
- High school diploma required.
- At least 5 years of healthcare experience.
- Minimum 5 years of experience in hospital financial operations, including reimbursement, medical billing, charge master development and maintenance, medical records/coding, and charge audit experience.
- Broad knowledge of hospital financial operations, reimbursement, coding, and charge master processes.
- In-depth knowledge of CPT, HCPCS, and ICD-10 coding, as well as APC Medicare reimbursement.
- Epic Contracts Module certification preferred upon hire.
- Strong oral and written communication skills.
- Ability to analyze data, interpret information, organize work, and manage projects.
- Must be highly motivated, self-starting, and accurate.
- Confidentiality is essential.
- Travel to off-site locations may be required.
Benefits & Perks
- Concierge services
- Employee lounge
- Wellness programs
- Free covered parking
- Free on-site and virtual health clinics
- Additional employee perks and recognition programs
Location
N/A
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
Yes
Posted
3 weeks ago