Revenue Cycle Reimbursement Auditor
Join a dynamic and innovative team dedicated to excellence in healthcare reimbursement. At Titan, we are committed to ensuring accurate and timely payments, fostering a collaborative environment where your skills will directly impact our mission of identifying underpayment patterns to maximize revenue recovery for our clients.
Essential Job Duties/Responsibilities
As a Reimbursement Auditor, you will play a pivotal role in ensuring our clients' claims are processed accurately and identifying areas where additional revenue can be pursued. Your responsibilities will include:
- Audit Excellence: Conduct thorough audits of hospital insurance claims payments, including Medicare and Medicaid, ensuring compliance with coding rules and payment standards. Perform in-depth research to verify the accuracy of claim payments or the legitimacy of denials, including proactive communication with insurance plans when necessary.
- Contract Insight: Analyze contract language to identify potential areas for payment errors before they occur, contributing to proactive management of reimbursement processes.
- Error Identification: Detect and verify underpayments by insurance plans, ensuring accurate financial reconciliation for our hospital.
- Appeal Craftsmanship: Develop compelling appeal and grievance arguments, including precise calculations of short payments. Draft and submit appeal letters or reconsideration requests via various channels (phone, fax, email, or payor portal).
- Appeal Management: Review and audit paid appeal amounts to confirm accurate resolution. Draft and submit secondary appeals when necessary, ensuring comprehensive follow-up on underpaid accounts.
- Collaborative Collection: Assist in the collection of appeals by effectively communicating with insurance plans to expedite accurate payments when needed.
- Team Culture: Upholds organizational values to help foster a trusting and respectful work environment.
- In-Depth Knowledge: Expertise in Commercial, Medicare, and Medicaid claims, including a thorough understanding of billing, coding rules, and claim forms (UB04 and HCFA 1500) and reimbursement. Along with, detailed understanding of CPT/HCPCS and ICD10 coding.
- Analytical Skills: Proficiency in contract analysis and interpretation with at least 1 year of experience in contract analysis and hospital or physician claims auditing.
- Appeal Experience: Hands-on experience with payor reconsiderations and appeals, including drafting appeal letters and following up with payors.
- Technical Skills: Proficiency in Microsoft Office (Word and Excel) with at least 1 year of experience. Certification such as Certified Outpatient Coding (COC) or Certified Professional Coding (CPC) is preferred.
- Communication: Exceptional oral and written communication skills, with a focus on customer and client service.
- Work from home: your workspace should be large enough to work efficiently with reliable internet connectivity.
- Attitude: Demonstrate a positive and professional demeanor toward supervisors, co-workers, and clients.
- Reliability: Show commitment and initiative in your role, with a strong focus on job performance and follow-through.
- Quality: Deliver high-quality work with attention to detail and accuracy.
- High school diploma or equivalent.
- Proficiency in Microsoft Office (Word and Excel) with at least 1 year of experience.
- 2 years prior experience in reimbursement auditing, contract and financial review.
- CPC-A, CPC preferred