Payer Integrity Specialist/UKHC

Job description

Under the direction of the Assistant Director and Contract Compliance Manager, the Payment Integrity Specialist is responsible for the collection and resolution of both inpatient and outpatient accounts from governmental, commercial, and/or managed care payers through the efficient analysis of payments in accordance with managed care contracts. This position is primarily concerned with effectively capturing accurate reimbursements, pursuing underpayments, and appealing denials.

The Specialist will review, analyze, and interpret claims to ensure accurate payments are received, payor contractual agreements and models are appropriate and complete, and all charges are valid. The Payment Integrity Specialist will also administer payor profiling to assist in contractual review and analysis for UK Managed Care contract negotiations and assist the UKMC Utilization Management Department with retrospective authorizations and appeals.

The individual in this position will be responsible for the proactive identification of improved methods to accomplish Enterprise goals and must demonstrate flexibility in assignments to ensure those goals are achieved. Specialist will also provide customer service to both internal and external customers to provide for the sufficient collection of funds in order to support healthcare operations and participate in unit and Enterprise efforts to improve quality, efficiency, safety, and patient satisfaction.

Job Title
Payer Integrity Specialist/UKHC

Requisition Number

Working Title
Payment Integrity Specialist/UKHC

Department Name
H4014:Patient Accounts

Work Location
Lexington, KY

Grade Level

Salary Range

Type of Position

Position Time Status

Required Education


Click here for more information about equivalencies:

Required Related Experience

3 yrs

Required License/ Registration/Certification


Physical Requirements

This position requires the ability to occasionally stand or walk with objects weighing up to 25 lbs.; and regularly sit at a computer workstation for extended periods of time performing tasks requiring repetitive motions (such as typing).


Primarily Monday through Friday, 8:00am-4:30pm; some nights, weekends, and/or holidays may be required in order to meet job and departmental needs.


The ideal candidate will have a proficient understanding of the Revenue Cycle process and managed care contracts; strong analytical, critical-thinking, problem-solving, time management, follow-through, and planning and organizational skills; the ability to multi-task with a high regard for confidentiality, accuracy, and attention to detail; excellent communication skills, both written and verbal; extensive experience with and knowledge of Microsoft Office, specifically the applications Word, Outlook, PowerPoint, and Excel; in-depth HIPAA knowledge and medical, financial, and contractual terminology; proficient knowledge of medical coding (ICD-10, HCPCS, CPT); the ability to meet goals in a fast-paced setting without sacrificing quality or accuracy; and an individual who provides exceptional customer service and possesses a teamwork mentality, but can also thrive independently. Must also have the ability to compute basic math calculations using addition, subtraction, multiplication, division, and percentages.

Experience with the following systems is a plus: McKesson, Allscripts Electronic Health Record (AEHR), EPSI, Sunrise Clinical Manager (SCM), Document Management System (DMS), Sunrise Record Manager (SRM), PageCenter X (PCX), Availity, 3M, ComplyTrack, Ambulatory Practice Management (APM), RevRunner, Navinet, SSI Billing, and Payment Integrity Compass (PIC).

Does this position have supervisory responsibilities?

Preferred Education/Experience

Bachelor's degree and four or more years of third party insurance claims experience and at least three years of payer contract analysis and medical office/clerical employment experience highly preferred.

Deadline to Apply

University Community of Inclusion

The University of Kentucky is committed to a diverse and inclusive workforce by ensuring all our students, faculty, and staff work in an environment of openness and acceptance. We strive to foster a community where people of all backgrounds, identities, and perspectives can feel secure and welcome. We also value the well-being of each of our employees and are dedicated to creating a healthy place to work, learn and live. In the interest of maintaining a safe and healthy environment for our students, employees, patients and visitors the University of Kentucky is a Tobacco & Drug Free campus.

As an Equal Opportunity Employer, we strongly encourage veterans, individuals with disabilities, women, and all minorities to consider our employment opportunities.

Any candidate offered a position may be required to pass pre-employment screenings as mandated by University of Kentucky Human Resources. These screenings may include a national background check and/or drug screen.

Posting Specific Questions

Required fields are indicated with an asterisk (*).

  1. * Please describe a time when you identified and successfully resolved a payment/reimbursement dispute with a payer and include specific details regarding the situation.

    (Open Ended Question)

  2. * Please indicate the number of years of paid work experience you have analyzing and supporting healthcare or financial/revenue cycle initiatives, including working with insurance contracts, overpayments, and underpayments.
    • None
    • More than 0, up through 1 year
    • More than 1 year, up through 3 years
    • More than 3 years, up through 5 years
    • More than 5 years
  3. * Please indicate the number of years of paid work experience you have in a position that was responsible for business reporting and analytics.
    • None
    • More than 0, up through 2 years
    • More than 2 years, up through 4 years
    • More than 4 years, up through 6 years
    • More than 6 years
  4. * University of Kentucky HealthCare recognizes a set of values that guide us in our daily interactions. By applying for a position within UK Healthcare, you are indicating your commitment and expressing your agreement to our five values. These values are diversity, innovation, respect, compassion, and teamwork. Please choose one of the UK Healthcare values and give a specific example when you exhibited this quality in your professional experience.

    (Open Ended Question)

  5. * Where did you first see this position advertised other than on UK's online employment system?
    • (Diverse Issues in Higher Education)
    • (Higher Education Recruitment Consortium)
    • Institute for Diversity in Health Management
    • A Colleague, Friend and/or Family Member
    • None of the Above

Applicant Documents

Required Documents
    Optional Documents
    1. Resume
    2. Cover Letter





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    Job No:
    Posted: 12/13/2018
    Application Due: 1/17/2019
    Work Type: