Claims Quality Auditor

Overview:

The Claims Quality Auditor 1 is responsible for auditing charge accuracy and compliance with policies and procedures and providing recommendations on quality/process improvement as identified in the audits. In addition, this position monitors suspended charges and manages assigned charge entry duties.

This is a Remote position - "NAH reserves the right to make hiring decisions based in part on applicants' state of residence if outside the state of Arizona".

Auditing
* Identifies and relays coding opportunities through edit and denial patterns.

* Identifies charge accuracy issues through edit and denial patterns.

* Performs all necessary research to correctly verify assigned rejection legitimacy.

* Analyze adverse billing trends and present information and possible solutions to management.

 
Quality
* Confirms compliance with policies and procedures through review of edit and denial patterns.

* Provides recommendations to leadership on workflow process, policies and procedures to improve billing outcomes.

 
Account Reconciliations
* Monitors accounts receivable activity and initiates appropriate actions as needed.

* Analyze billing discrepancies between charge entry, coding and CBO for proper claim filing..

* Complete special projects as assigned.

 
Compliance/Safety
* Responsible for reporting any safety-related incident in a timely fashion through the Midas/RDE tool; attends all safety-related training programs; performs work in a safe manner; monitors work environment for possible safety issues and ensures others are also performing work in a safe manner.

* Stays current and complies with state and federal regulations/statutes and company policies that impact the employee's area of responsibility.

* If required for the position, ensures all certifications and/or licenses are up-to-date and valid prior to expiration dates.

* Completes all company mandatory modules and required job-specific training in the specified time frame.

Education
Associate degree or 2 years of equivalent experience - Required

Certification & Licensures
Certified Coding Associate or equivalent - Preferred

Experience
2-3 years billing/coding experience - Required

Healthcare is a rapidly changing environment and technology is integrated into almost all aspects of patient care. Computers and other electronic devices are utilized across the organization and throughout each department. Colleagues must have an understanding of computers, and competence in using computers and basic software programs.