Revenue Cycle Reimbursement Auditor

• 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

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