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Payer Audit Coordinator- P. Health

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Remote Position


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