Auditor 2 - Zero Balance

5 days ago

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CorroHealth

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CorroHealth is a leading provider of clinically led healthcare analytics and technology-driven solutions, focused on enhancing the financial performance of hospitals and health systems. Their integrated solutions and advanced technologies aim to optimize the entire revenue cycle, offering services such as revenue cycle management, clinical documentation, medical coding, and denials management. With a commitment to improving financial health through intelligent technology and expert guidance, CorroHealth addresses complex payer-provider relationships and supports efficient healthcare operations.

Revenue Cycle Management • Revenue Integrity • Healthcare Data and Analytics

5001 - 10000 employees

⚕️ Healthcare Insurance

☁️ SaaS

🤖 Artificial Intelligence

📋 Description

• Healthcare Auditors develop contract models for analysis and identify potential insurance reimbursement issues through extensive reviews of hospital claim data and related documents. • Auditors also contribute to our knowledge base by conducting research on reimbursement risk areas, reviewing data and processes for quality control, and providing feedback for areas of improvement. • Create and update audit plans, including outlining potential risk areas of a hospital-payer contract based on reimbursement structure and how to manually identify within the data. • Model and create/update pricing documents based on hospital contracts to calculate expected payments, including percentage of charge, per diems, MSDRG, outlier and/or stoploss, implants, drugs, Medicare, Medicaid, some outpatient, and other reimbursement models. • Review insurance payments, research applicable sources (contracts, state and federal legislation, insurance payer policies, medical records, etc.) to determine if payment is correct and make recommendations on appropriate next steps. • Identify contractual and clinical risk areas from commercial and government payors (e.g., Medicare, Medicaid) as well as other specialized audits (such as coordination of benefits and workers’ compensation). • Develop specifications and procedures to identify and troubleshoot contractual, coding, and administrative areas of underpayment risk using Access, SQL, Excel, and other programs. • Conduct review of zero-balance hospital accounts to identify underpaid inpatient and outpatient claims. • Present clear documentation of process, findings, and results of audits. • Make recommendations to improve internal processes and external client contracts/processes. • Work with data analyst team to build and validate pricing models. • Work across project teams to research and outline next steps on identified underpayment trends. • Other duties as assigned.

🎯 Requirements

• High School Diploma or equivalent required • Minimum of 3 years of experience working with large sets of (healthcare) data • Minimum of 2 years of experience in areas of research and analysis • Minimum of 2 years of experience with managed care contracts (government and commercial) and hospital reimbursement • Minimum of 2 years of experience working with inpatient claims • Minimum of 1 year of experience working with Medicare, Medicaid, outpatient facility claims • Minimum of 1 year of experience with contract modeling • Ability to translate complex contract language and healthcare data into actionable information and insights • Ability to work independently to solve problems and recommend technical solutions (ex. provide calculation/formula to price in Alteryx) • Intermediate Excel skills, including knowledge of complex formulas and functions (CONCATENATE, IF, pivot tables) • Basic knowledge of Access (link tables, select/update query, manipulate data in tables) and SQL preferred • Strong verbal and written communication skills • Strong organization skills and attention to detail