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Payer Audit Coordinator- P. Health

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Remote Position

 

Objective:
 
Reporting directly to the Payer Process Manager, the Payer Audit Coordinator will be responsible for performing analysis of payer audit or medical record requests, present findings, define training needs/process improvements and manage post payment review process.
 
Essential Duties & Responsibilities:

  • Coordinate payer audit activities with audit clients and interact with support and management staff while maintaining departmental goals, policies and initiatives’ 
  • Take prompt action to review, diagnose and understand new payer audit requests, document in audit log and respond timely.
  • Ability to adjust work assignments to account for shift or unforeseen events impacting daily workload.
  • Ability to analyze payer trends and develop strategies to ensure continuous improvement of results or alleviate defects.
  • Evaluate payer audit discrepancies against policies, State/Federal and Payer contract language to ensure audit results comply with required guidelines and challenge when appropriate.
  • Communicate with audit payers, firms and internal departments on audit activities & observations in a cooperative and respective relationship.
  • Establish effective intra- and inter- departmental communication while consistently demonstrating a professional and high standard of conduct, ethics, objectivity, judgment, independence, and discretion.
  • Respond to internal and external customer questions professionally, timely and accurately.

Authority and Accountability:

  • Responsible for maintaining audit entry, tracking,   updating and maintaining log within the Comply Track software.
  • Communicates regularly with RCM Management and Pharmacy of requests for on-site audits or large dollar requests from a single payer.

Skills, Competencies and Experience:
Required

  • Strong healthcare background with experience in collections or billing medical professional claims, multiple types of  payers and coding
  • Excellent critical thinking, organizational and time management skills with a strong attention to detail, accuracy, and follow through.
  • Exhibits professionalism in all aspects of work
  • Excellent verbal and written communication skills and the ability to interact professionally with a diverse directors, managers, colleagues, and external customers.
  • Demonstrates professionalism with internal and external customers (and other people and/or companies as needed)
  • Assesses situations to determine corrective action plans or actions needed for resolution in conjunction and with guidance from Supervisor or Manager
  • Works independently as needed to finish own work assignments but also manages team environments successfully to maximize department, output and accuracy

 
 
Preferred

  • Prior experience with billing and collections related to home infusion therapies
  • knowledgeable of CPR+
  • Microsoft Excel

Education, Certifications, Trainings:
 
Required

  • High School Diploma
  • At least 2 years’ Healthcare experience  

 
Preferred

  • Demonstrated superior knowledge of departmental processes and procedures
  • Demonstrated outcomes in current job as measured by MBO attainment and excellent performance review
  • Associate’s or Bachelor’s Degree