Payer Audit Specialist-Revenue Integrity- 40 hrs/week

Company: EvergreenHealth
Location: Kirkland
Posted on: January 26, 2023

Job Description:

Job Summary:
Coordinates all audit activities related to the Medicare Recovery Audit Contractor (RAC) Program, Medicare Administrative Contractor (MAC), Comprehensive Error Rate Testing (CERT) reviews, commercial payers, etc. Logs and tracks audit records requests and organizes, evaluates and tracks appeal processes at all levels. Ensures that audit findings are reviewed timely and appeals are completed and submitted within payer deadlines. Responsible for monitoring trends found in audit requests and denials and providing education materials to team members for one-on-one education to physicians and their office staff.

Primary Duties:
1. Organize and document all payer audits in the C360 tracking tool and update with changes and completions.
2. Communicate and coordinate across departments to ensure audits receive the proper review, appeals and resolution.
3. Coordinates with other departments (HIM, Care Management, Physician Offices, etc.) to obtain appeal responses and justification and compiles responses and submits in appropriate format and according to payer requirements.
4. Reviews and evaluates hospital bill audits to determine appropriate course of action. Develops and writes appeal rationale and submits according to payer requirements.
5. Responds timely to all payer audit requests and submits appeals within payer deadlines.
6. Analyzes trends from audit requests and denials and provides to stakeholders for education and process improvement.
7. Monitors RAC/MAC and private payer related resources and websites to identify changes in payer requirements and other relevant audit information and incorporates into existing audit processes.
8. Develops reporting on audit activity for presentation to stakeholders at committee meetings.

Minimum Qualifications
License, Certification, Education or Experience:
REQUIRED for the position:
* Bachelor's degree in related area or equivalent combination of education and experience
* 3 years of experience working with hospital, physician billing systems or the insurance field
* Familiarity with healthcare regulations, billing complexities and guidelines
* Auditing experience
* Familiarity with Medicare/Medicaid and Commercial payer reimbursement methodologies
* Experience coordinating and collaborating with interdepartmental teams.

DESIRED for the position:
* Medical terminology

PI201950029

Keywords: EvergreenHealth, Kirkland , Payer Audit Specialist-Revenue Integrity- 40 hrs/week, Human Resources , Kirkland, Washington