Payment Integrity Representative

Sanford Health

. Review, maintain, and analyze underpayment records and managed care contracts .

Posted 11/11/2026full-timeRemote • United StatesMid-LevelSenior💰 $19 - $31 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in healthcare reimbursement analysis, managed care contracts, and payment classification systems while effectively managing relationships with payers and internal departments. Proficient in developing standard operating procedures and conducting thorough reimbursement analysis to ensure compliance and maximize revenue.

Highest-signal resume keywords

Healthcare Revenue Cycle ExperienceManaged Care Contract AnalysisReimbursement AnalysisExcel Spreadsheet ProficiencyNegotiation Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Reimbursement AnalysisManaged Care Contract AnalysisPayment Classification SystemsFee SchedulesPayer Remark CodesPayer Reason CodesClaim AdjudicationOperational Error IdentificationClaims ResearchTrend Analysis

Soft Skills

CommunicationRelationship ManagementConsensus-BuildingNegotiationAdaptability

Tools & Technologies

OneNoteExcel

Industry Keywords

HealthcareRevenue CycleManaged CareCompliancePayer Guidelines

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

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