Payment Integrity Representative

🔥 15 hours ago

🌾 Iowa, North Dakota, +4 more states – Remote

🌾 Iowa – Remote 🌾 North Dakota – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🗿 South Dakota – Remote 🧀 Wisconsin – Remote

💵 $19 - $30 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Sanford Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1894

🛡️ Insurance

🏥 Healthcare

⚕️ Healthcare Insurance

Insurance • Healthcare • Healthcare Insurance

Sanford Health is the largest rural health system in the United States, dedicated to transforming the healthcare experience and providing access to world-class healthcare in America's heartland. Headquartered in Sioux Falls, South Dakota, Sanford Health serves over 1. 4 million patients and nearly 200,000 health plan members across 250,000 square miles. The integrated health system includes 48 medical centers, 211 clinic locations, and more than 160 senior living centers, employing 2,900 physicians and advanced practice providers. Sanford Health is committed to offering compassionate care through its Centers of Excellence, focusing on specialties such as cancer, orthopedics, women’s health, and genetics. Additionally, it provides affordable health insurance, engages in extensive clinical trials, and supports personalized genetic medicine.

📋 Description

• Review, maintain, and analyze underpayment records and managed care contracts • Ensure Sanford is paid according to contract terms and maximize reimbursement while maintaining compliant practices • Develop, document, and oversee standard operating procedures in OneNote for claim adjudication business rules • Analyze reimbursement techniques, fee schedules, payment classification systems, payer Remark and Reason codes, and remittance advice • Manage appeals related to underpayments and overpayments according to internal guidelines • Conduct reimbursement analysis and testing by payer and analyze managed care issue trends • Review managed care activity in the system and determine whether payments comply with contracts and payer guidelines • Identify operational errors, research coverage setup issues, and provide guidance • Identify and communicate enrollment issues for new payers • Investigate claim variance patterns and systemic payer claim-system issues • Educate and distribute relevant information to internal departments and payers • Contact payers to identify underpayment issues and collate findings for resolution • Support billing and finance with analysis and reporting for operational decision-making • Cultivate relationships with management, staff, departments, and payers while negotiating and building consensus

🎯 Requirements

• Associate degree in healthcare or business-related field required, or minimum three years of prior healthcare revenue cycle experience in lieu of education • Experience working with Excel spreadsheets required • Minimum two years of prior healthcare experience with an understanding of healthcare reimbursement preferred • Must meet standard productivity requirements before moving to a home-based position • Director approval required to move to a home-based position if meeting productivity requirements with less than one year working in a Sanford office • Ability to analyze managed care contracts, fee schedules, reimbursement/payment classification systems, remittance advice, and payer Remark and Reason codes • Ability to research claims, identify payment errors and systemic payer issues, analyze trends, and interpret complex contracts • Skilled in negotiation, consensus-building, communication, and relationship management • Ability to work in a fast-paced, high-volume, changing environment

🏖️ Benefits

• Flexible work arrangements, including potential move to a home-based position after meeting productivity requirements • Flexible team environment • Day shift schedule • 40 scheduled hours per week

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