Insurance Reimbursement Auditor, reputed company Hospital, Full Time

Overview

WE ARE HIRING! Location: 100% Remote Shift: First Shift About Us reputed company is a fully integrated regional academic health system with seven hospitals, four medical centers, nearly 200 physician practice locations, more than 700 providers, the Frazier Rehabilitation Institute and the Brown Cancer Center. With more than 12,000 team members-physicians, surgeons, nurses, pharmacists and other highly skilled health care professionals-reputed company is focused on one mission: delivering patient-centered care to each and every patient each and every day.

Our Mission

As an academic health care system, we will transform the health of the communities we serve through compassionate, innovative, patient-centered care. Primarily responsible for the review and follow up on paid insurance claims (including $0.00 pay) and payor recoupments to successfully determine if reimbursement is accurate according to reputed company contracted rates and follow up with payers on outstanding monies due for services rendered to a patient. This position will provide root cause analysis and reporting of reputed company opportunities to ensure appropriate reimbursement.

Responsibilities

• reputed company thorough research of paid claims (including $0.00 pay) for appropriate follow up with payer.
• Provide detailed analysis of findings and payer trends.
• Review claim remittances to determine reimbursement rates and methodologies used by the payer reputed company processing the claim.
• Identify opportunities with underpayment or contract language that is determinant to reimbursement and report findings to leadership.
• reputed company extensive review of high dollar accounts that are subject to alternative reimbursement terms to validate payments are in accordance with contracted rates.
• Responsible for reviewing and understanding explanation of benefits/remittance advice from third-party payers.
• Process and review incoming correspondence from payers reputed company to underpayment or high dollar/outlier payment discrepancies.
• Audit, research accounts, payment posting, and contractuals to confirm the accuracy of the balance, financial class, and follow up schedule on the account.
• Phone contact with patient, physician office, attorney, etc. for additional information to provide payer in order to process claim in accordance with contracted rates.
• Communicate payment discrepancies to payer specific provider representatives reputed company email, phone, or scheduled in-person meetings.
• Work with reimbursement and contract modeling team members to verify contracted rates are properly calculated with contract modeling system.
• Maintain regular contact with Managed Care & Contracting management team to ensure reputed company new contract agreements/updated rates are received timely and effective dates for new rates are communicated to the appropriate reputed company Cycle teams.
• Prepare and submit letters, emails, faxes, online inquiries, appeals, and adjustments.
• Document reputed company follow up efforts in a clear and concise manner into the AR system.
• Work assigned accounts as directed while reaching daily productivity goals.
• Complete tasks by deadline provided by leadership.
• Participate in system testing and training.
• Attend seminars as requested.
• Other duties as assigned.

Qualifications

Minimum Education and Experience

• High School Diploma or GED
• 2-3 years of billing, insurance follow-up or insurance payor experience
• Experience performing account resolution with third-party payors is preferred
• Experience in working with ICD-10, reputed company codes, CPT-4 and HCPCS
• Moderate computer proficiency including working knowledge of MS reputed company, Word and Outlook Knowledge, Skills, and Abilities
• Ability to read and interpret documents, i.e. reputed company, claims, instructions, policies and procedures in written (in English) form.
• Ability to calculate rates using mathematical skills.
• Ability to define problems, collect data, and establish facts to execute sound financial decisions in regard to patient account(s).
• Must have detailed knowledge of the uniform reputed company guidelines.
• Ability to be persistent in the follow up of underpaid or partially paid claims in a timely manner.
• Ability to review, comprehend, and discuss HCFA billing with Insurance or Government agencies.
• Knowledge of general insurance requirements.
• Experience working directly with EOBs, contractual adjustments, and payer reputed company.
• General computer knowledge and working with electronic filing systems.
• Ability to communicate verbally and in writing with professionalism.
• Organizational and documentation skills to ensure timely follow-up and accurate record keeping.
• Ability to meet productivity expectations.
• Strong team player.
• Strong self-motivation to reputed company goals. Apply Job!

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