Revenue Cycle Reimbursement Auditor

Work set-up: 
Full Remote
Contract: 
Experience: 
Mid-level (2-5 years)
Work from: 

Offer summary

Qualifications:

Experience in reimbursement auditing, with at least 2 years in hospital or physician claims review., Proficiency in billing, coding rules, and claim forms like UB04 and HCFA 1500., Knowledge of CPT/HCPCS and ICD10 coding standards., Excellent communication skills and proficiency in Microsoft Office..

Key responsibilities:

  • Conduct audits of hospital insurance claims to ensure compliance and accuracy.
  • Analyze contract language to identify potential payment errors.
  • Develop and submit appeal letters for underpaid claims and follow up on resolutions.
  • Collaborate with insurance plans to expedite accurate payments.

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Titan Health Management Solutions
51 - 200 Employees
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Job description

Join a dynamic and innovative team dedicated to excellence in healthcare reimbursement. At Titan, we are committed to ensuring accurate and timely payments, fostering a collaborative environment where your skills will directly impact our mission of identifying underpayment patterns to maximize revenue recovery for our clients. 
 
Essential Job Duties/Responsibilities 
As a Reimbursement Auditor, you will play a pivotal role in ensuring our clients' claims are processed accurately and identifying areas where additional revenue can be pursued. Your responsibilities will include: 
 
  • Audit Excellence: 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. 
  • Contract Insight: Analyze contract language to identify potential areas for payment errors before they occur, contributing to proactive management of reimbursement processes. 
  • Error Identification: Detect and verify underpayments by insurance plans, ensuring accurate financial reconciliation for our hospital. 
  • Appeal Craftsmanship: 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). 
  • Appeal Management: Review and audit paid appeal amounts to confirm accurate resolution. Draft and submit secondary appeals when necessary, ensuring comprehensive follow-up on underpaid accounts. 
  • Collaborative Collection: Assist in the collection of appeals by effectively communicating with insurance plans to expedite accurate payments when needed. 
  • Team Culture: Upholds organizational values to help foster a trusting and respectful work environment. 
 
Minimum Qualifications 
  • 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) and reimbursement.  Along with, detailed understanding of CPT/HCPCS and ICD10 coding. 
  • 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. 
 
Work Environment 
  • Work from home: your workspace should be large enough to work efficiently with reliable internet connectivity.  
 
Performance Standards 
  • Attitude: Demonstrate a positive and professional demeanor toward supervisors, co-workers, and clients. 
  • Reliability: Show commitment and initiative in your role, with a strong focus on job performance and follow-through. 
  • Quality: Deliver high-quality work with attention to detail and accuracy. 
Technical Skills:
  • High school diploma or equivalent.
  •  Proficiency in Microsoft Office (Word and Excel) with at least 1 year of experience.
  • 2 years prior experience in reimbursement auditing, contract and financial review. 
  • CPC-A, CPC preferred

 

Required profile

Experience

Level of experience: Mid-level (2-5 years)
Spoken language(s):
English
Check out the description to know which languages are mandatory.

Other Skills

  • Microsoft Office
  • Customer Service
  • Detail Oriented
  • Communication
  • Analytical Skills

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