Reimbursement Auditor

About the position

The Reimbursement Auditor maintains data integrity of the Reimbursement Software. The auditor ensures that all Government requests are submitted timely and all appeals and response deadlines are met. The Auditor tracks, collects and enters data into the specified applications and/or systems, prepares reports and other documentation, combines and rearranges data from different sources and prepares reports for department director. Responsible for routine analysis of data applications and/or systems for data integrity and completion.

Responsibilities

• Denials are reviewed, logged and assigned to appropriate department within 5 days of receipt of denial letter/EOB.
• A professional and grammatically correct correspondence using appropriate letter based on the type of denial is composed and a 93% accuracy rate is maintained.
• An appeals letter is submitted to private payor(s) 5 days prior to due date.
• Data is entered accurately into denial tracking system and denial spreadsheet within 5 business days following receipt of denial.
• All denials are easily accessible, clearly categorized and organized accurately.
• Monthly summaries of denials are completed by payer and dollar amount. Report submitted to manager, director and or administration by 5th of month.
• On-going trend analysis is provided to identify the reason for the denial and corrective action steps are applied to protect revenue integrity by 10th of month.
• Month-to-month analysis of at risk revenue and appeals received are reported by the 10th of the month.
• Month-to-month analysis of closed appeals and appeals overturned are reported by the 10th of the month.
• The auditor reports to manager any delays, issues or denial patterns with payers on weekly basis.
• Assistance is provided to the manager for the development of department education related to denial types and trends.
• Follow up analysis of effectiveness of educational activity is performed; findings are reported to manager monthly.
• Participation is conducted quarterly in at least one quality improvement activity.
• Assistance is provided to the revenue cycle and business office functions at month end or year end as requested by manager or director.
• Other duties as assigned are completed.

Requirements

• 5 years acute care hospital billing/claims adjudication.
• High School or equivalent. Bachelor's Degree substitutes for 4 years experience.
• Excellent oral & communication skills.