Payment Integrity Analyst

Inova is 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.

About the role

This is a full-time, hybrid position with a Monday through Friday schedule.

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 escalates 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.
• Performs additional duties as assigned.

Requirements

• 6 years of experience in Payment Integrity, Denials Management, or similar roles.
• 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.

Benefits

• Committed to Team Member Health: Medical, dental, and vision coverage, plus 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: Up to $5,250 per year in education assistance and up to $10,000 for student loans.
• Mental Health Support: 25 mental health coaching or therapy sessions per person, per year, at no cost for team members, their spouses/partners, and their children.
• Work/Life Balance: Paid time off, paid parental leave, flexible work schedules, and remote/hybrid career opportunities.