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LifeBridge Health · 7 hours ago

Payment Integrity Analyst

Owings Mills, MD

Full-time

Onsite

Mid Level

3+ years exp

LifeBridge Health is a dynamic health system focused on improving community health. The Payment Integrity Analyst will monitor and investigate discrepancies in medical claim reimbursements, ensuring accurate billing and coding practices while taking corrective actions to maximize collections.

AssociationFitnessHealth CareNon Profit

Responsibilities

Analyzing payment data: Reviews payment variances to identify trends and patterns in underpayments or overpayments from payers

Payer contract review: Understands and interprets payer contracts and their reimbursement methodology utilized in healthcare payments to ensure accurate billing practices and identify potential reimbursement issues based on fee schedules, payer policies and coding guidelines

Root cause analysis: Investigates the reasons behind payment variances

Evaluate and identify insurance payment variances from zero payments, full denials, and line-item denials, and determine root cause of underpayments

Take necessary actions to recover insurance underpayments due to payer downcoding, incorrect coding, billing errors, system glitches, or payer policy changes

Appeals management: Initiates appeals for payment variances. Contacts payer, gather and compare pricing information via EOBs, contracts, payor policies, patient benefits to effectively initiate appeals

Collaborate with payer representatives and LifeBridge Health’s Managed Care department to resolve billing disputes and recoup underpayments

Reporting and communication: Generate comprehensive reports on payment variance trends, identify areas of improvement and communicate findings to leadership

Process improvement initiatives: Works closely with each department responsible for root causes to assist in preventing underpayments. Participates in projects to streamline billing processes, improve claim accuracy, and minimize payment variances

Qualification

Certified Coding SpecialistCertified Professional CoderPayment variance analysisPayer contract reviewRoot cause analysisAppeals managementCommunicationCollaboration