Revenue Cycle Auditor

December 9

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Titan Health Management Solutions

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Medical Reimbursement Audits (incl Zero Balance) • Medical Insurance Collections • Clinical Denials and Recovery • Revenue Cycle Management • Zero Balance Audit

51 - 200 employees

⚕️ Healthcare Insurance

💸 Finance

☁️ SaaS

Description

• 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. • Analyze contract language to identify potential areas for payment errors before they occur, contributing to proactive management of reimbursement processes. • Detect and verify underpayments by insurance plans, ensuring accurate financial reconciliation for our hospital. • 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). • Review and audit paid appeal amounts to confirm accurate resolution. • Draft and submit secondary appeals when necessary, ensuring comprehensive follow-up on underpaid accounts. • Assist in the collection of appeals by effectively communicating with insurance plans to expedite accurate payments when needed.

Requirements

• 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). • 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.