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:
- 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
- Prior experience with billing and collections related to home infusion therapies
- knowledgeable of CPR+
- Microsoft Excel
Education, Certifications, Trainings:
- High School Diploma
- At least 2 years’ Healthcare experience
- 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