Claims Audit Supervisor, Revenue Cycle Managment

Cardinal Health; Geldern; Remote; EUR 61,000 - 78,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

401k plan

HSA access

Job summary

Cardinal Health in the US is seeking a Revenue Cycle Management Auditor to lead audit activities, assure QA quality, and improve compliance with federal and state regulations. You will oversee audit processes, respond to auditors, and coordinate with CMS and payors to ensure timely, accurate documentation and payments.

The ideal candidate has 4–8 years of audit or RCM experience, a Bachelor’s degree, and strong leadership and project management skills, with knowledge of healthcare contracts and

Qualifications

• 4-8 years of experience, preferred.
• Bachelor's degree in related field, or equivalent work experience, preferred.
• Leadership, project management, or supervisory experience preferred.
• Urology or wound care product knowledge preferred.

Responsibilities

• Oversee audit team and respond to audit requests in a timely manner and develop audit processes.
• Focus on quality assurance, quality improvement, and compliance with Federal and State regulations.
• Lead team reviewing clinical documentation for accuracy and compile response packets for audits.
• Collaborate with team members to complete tasks to the highest standards.
• Provide monthly feedback on audits, recoupment inquiries, and payor issues.
• Oversee all aspects of a TPE, CERT, RAC, pre/post payment audits and respond on time.
• Oversee recoupment or refund requests and respond within required time frame.
• Monitor, track, and trend current audits and documentation requests.
• Ensure communication with CMS and other auditors on issues as they arise.

Skills

Audit leadership

Project management

Team supervision

Urology knowledge

Education

Bachelor's degree or equivalent

Job description

US-Nationwide-FIELD

Full time

20188110

Remote Hours: Monday - Friday, 8:00 AM - 5:00 PM EST (or based on business needs)

What Revenue Cycle Management (RCM) contributes to Cardinal Health

Revenue Cycle Management (RCM) is responsible for managing the financial lifecycle of patient accounts and ensuring timely and accurate payment for services provided. This job family is focused on a series of clinical and administrative processes that healthcare providers utilize to capture, bill, and collect patient service revenue in a manner that is compliant with payer rules and requirements. The revenue cycle shadows the entire patient care journey and begins with patient intake and ends when the patient’s account balance is zero. This team also encompasses a payer administration function that ensures we are successfully operationalizing payer rules and requirements as well as facilitating payer relations and escalation efforts.

Responsibilities

• Will be responsible for overseeing the Audit team and responding to all audit requests received by the company in a timely manner in addition to developing and implementing audit processes.
• The role will focus on quality assurance, quality improvement, and collaborative activities to support company compliance initiatives in accordance with Federal and State regulations.
• Lead dedicated team responsible for reviewing validity of clinical documentation for accuracy and compile response packets for successful audits.
• Will work with any additional team members to ensure all tasks are completed in a timely manner and to the highest standards possible.
• Will provide feedback on successes and failures on a monthly recurring basis and cover areas related to all audit or recoupment inquiries, payor collections inconsistencies, as well as business operations policies and procedures.
• Oversee all aspects of a TPE, CERT, RAC, pre/post payment, or 3rd party audit & respond in required time frame.
• Oversee all aspects of a Recoupment or Refund request and respond in required time frame.
• Monitor, track, and trend all current, in progress, and completed audits.
• Gather and review all documentation for audits, recoupments, or other documentation requests from insurance companies for accuracy and submission approval.
• Ensure good communication with CMS and/or other auditors regularly about issues or concerns that arise.
• Ensure audits, both external and internal, meet all legal requirements and company policies.
• Review and timely release of all claims marked for QA Review on hold.
• Assist with development of company policies procedures and enforcing compliance.
• Perform extensive reviews of accounts to determine if correct payments were made to providers.
• Review provider contracts/ fee schedules to determine correct payment methodology.
• Prepare reports summarizing findings and recommending corrective action.
• Stay up to date on current industry standards and regulations and serve as subject matter expert for Medicare updates and educational trainings.
• Perform other duties as assigned.

Qualifications

• 4-8 years of experience, preferred
• Bachelor's degree in related field, or equivalent work experience, preferred
• Leadership, project management, or supervisory experience preferred.
• Urology or wound care product knowledge preferred

What is expected of you and others at this level

• Coordinates and supervises the daily activities of operations or business staff
• Administers and exercises policies and procedures
• Ensures employees operate within guidelines
• Decisions have a direct impact to work unit operations and customers
• Frequently interacts with subordinates, customers, and peer groups at various management levels
• Interactions normally involve information exchange and basic problem resolution

Anticipated salary range: $68,500 - $87,930

Bonus eligible: No

Benefits:

• Medical, dental and vision coverage
• Paid time off plan
• Health savings account (HSA)
• 401k savings plan
• Access to wages before pay day with myFlexPay
• Flexible spending accounts (FSAs)
• Short- and long-term disability coverage
• Work-Life resources
• Paid parental leave
• Healthy lifestyle programs

The salary range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate’s geographical location, relevant education, experience and skills and an evaluation of internal pay equity.

Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law.

To read and review this privacy notice click here (https://www.cardinalhealth.com/content/dam/corp/email/documents/corp/cardinal-health-online-application-privacy-policy.pdf)

Headquartered in Dublin, Ohio, Cardinal Health, Inc. (NYSE: CAH) is a distributor of pharmaceuticals, a global manufacturer and distributor of medical and laboratory products, and a provider of performance and data solutions for healthcare facilities.

We are a crucial link between the clinical and operational sides of healthcare, delivering end-to-end solutions and data-driving insights that advance healthcare and improve lives every day. With deep partnerships, diverse perspectives and innovative digital solutions, we build connections across the continuum of care.

With more than 50 years of experience, we seize the opportunity to address healthcare's most complicated challenges - now, and in the future.

View Cardinal Health on YouTube (http://youtube.com/user/CardinalHealth)