Payer Reimbursement Auditor

The responsibilities of this job include, but are not limited to, the following:

• Participating with the Payer Relations team and assigned staff in the design of top-level and detailed reporting for the audit process;
• Vetting the data produced by the Remit Analysis program for accuracy and completeness; making changes to the program as directed;
• Participating in the analysis of resources required to carry out the audit function;
• Performing quality assurance audits (compile and analyze data) of all payers’ reimbursement on a scheduled basis to ensure contract reimbursement compliance using all programs and tools available;
• Analyzing data to determine root causes of reimbursement deficiencies and providing recommendations for resolution;
• Communicating with responsible parties and departments on areas of noncompliance; tracking and following up with all parties until concerns are resolved;
• Providing appropriate status reporting as directed;
• Attending various team meetings to address findings, understand contracts, and provide support when necessary;
• Communicating with payers and other third parties as requested;
• Working on additional projects as assigned;
• Operating, using, and maintaining office equipment as trained.

Minimum education requirements include, but are not limited to, the following:

• High school graduate or equivalent is required; some college education in a related field is preferred;
• At least two years of Patient First experience required;
• Strong knowledge of Patient First billing system required;
• Certified Professional Coder (CPC) certification required; Certified Professional Medical Auditor (CPMA) certification preferred;
• Five years of previous payor billing experience in a high-volume, high-number-of-payor-contracts environment is preferred;
• Ability to use Microsoft Excel, create and manipulate pivot tables and other data tools, and create complex formulas required; knowledge of other Microsoft products or data analysis software a plus;
• Excellent written and verbal communication skills;
• Must be able to prioritize and handle multiple tasks simultaneously.
• Self-starter with the ability to work independently and achieve productivity goals.