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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.
Featured Benefits:
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
Job 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.
Additional Requirements:
- 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
We are Inova, Northern Virginia’s leading nonprofit healthcare provider. Every day, our 26,000+ team members provide world-class healthcare to the communities we serve. Our people are the reason we're a national leader in healthcare safety, quality and patient experience. And from best-in-class facilities to professional development opportunities, we support them at every step. At Inova, we're constantly striving to be ever better — to shape a more compassionate future for healthcare.
Inova Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, pregnancy (including childbirth, pregnancy-related conditions and lactation), race, religion, sex, sexual orientation, veteran status, genetic information, or any other characteristics protected by law.
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