Role overview

Qualifications

Expertise in Commercial, Medicare, and Medicaid claims, including billing, coding rules, UB04/HCFA 1500, and CPT/HCPCS/ICD-10 coding.
At least 2 years of experience in reimbursement auditing, contract and financial review.
Hands-on experience with payor reconsiderations and appeals, including drafting appeal letters and follow-ups.
Proficiency in Microsoft Office (Word and Excel); CPC/COC certification preferred.

Responsibilities

Audit hospital insurance claims (Medicare and Medicaid) for accuracy, verify payments/denials, conduct in-depth research, and proactively communicate with insurance plans as needed.
Analyze contract language to identify potential areas for payment errors before they occur, contributing to proactive reimbursement management.
Identify underpayments and craft/draft compelling appeals (including reconsiderations) with precise calculations, manage follow-ups, and draft secondary appeals when necessary.
Coordinate appeal workflows by reviewing paid appeals for accuracy, assisting in collecting on underpayments, and maintaining a respectful, collaborative team environment.

Key facts

Remote from: Anywhere
Full time
Mid-level (2-5 years)
Auditor
English

Hard skills

ICD Coding (ICD-9/ICD-10) Contract Management Reimbursement Regulations Medicaid Billing Reimbursement Regulations Medical Billing Patent Applications Medicare Fraud Cash Management Outpatient Coding Online Communication Client Services

Other skills

Microsoft Word
Microsoft Excel
Professionalism
Non-Verbal Communication
Analytical Skills
Teamwork
Detail Oriented
Reliability

About the company

Titan Health Management Solutions

Titan Health Management Solutions (Titan) specializes in identifying and capturing unidentified sources of revenue for our hospitals and medical centers. Over the past 10 years, Titan has recovered over $35 Million for our hospital partners, revenues that the hospitals had adjusted to zero balance prior to Titan review. Titan provides services to hospitals and medical centers by reviewing both paid and denied claims, critically evaluating them, and identifying where underpayments exist. Titan provides full recovery services for its identified short pays – working through the payer to ensure that the correct payment is made to the facility. Our commitment is to identify and recover previously unidentified sources of revenue without impacting the already overburdened hospital administrative staff. The benefits to the hospital are straightforward: the collection of additional revenue that it did not realize existed, and would not have otherwise identified or collected. In addition, reported trends and high volume short pays assist the facility in tightening up contract terms and areas of leakage to reduce future short pays. The net impact is increased profitability and additional tools to maximize both current and future revenue.

Company details

Company size51 - 200

Links

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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

Salary Range: $20-25 hourly