Healthcare Documentation Auditor

Davita Inc.; United States; Remote; USD 44,000 - 51,000; Full time

Job summary

A leading healthcare payment integrity company is hiring a Healthcare Documentation Auditor in the US. The role involves reviewing medical records and billing accuracy for compliance with insurance coverage. Ideal candidates will have a strong background in medical terminology and demonstrate high attention to detail while maintaining deadlines. Various benefits including medical coverage and a flexible working environment are offered.

Benefits

Medical, dental, and vision coverage

401(k) savings plan

Paid family/parental leave

11 paid holidays per year

Sick and vacation time off annually

Qualifications

• At least two years' experience in adjudicating/examining claims.
• Demonstrated knowledge of medical terminology.
• Experience using Microsoft Excel and other Microsoft Office applications.

Responsibilities

• Review medical records for services billed and validate documents.
• Document review findings and reference policies in the audit platform.
• Collaborate with the audit team to identify vulnerabilities.

Skills

Attention to Detail

Medical Terminology

Communication Skills

Problem Solving

Organizational Skills

Education

High School Diploma or GED

Some college preferred

Job description

ABOUT PERFORMANT:

At Performant, we're focused on helping our clients achieve their goals by providing technology-enabled services which identify improper payments and recoup or prevent losses due to errant billing practices. We are the premier independent healthcare payment integrity company in the US and a leader across several markets, including Medicare, Medicaid, and Commercial Healthcare. Through this important work we accomplish our mission: To offer innovative payment accuracy solutions that allow our clients to focus on what matter most - quality of care and healthier lives for all.

If you are seeking an employer who values People, Innovation, Integrity, Fun, and fostering an Ownership Culture - then Performant is the place for you!

ABOUT THE OPPORTUNITY:

Hiring Range: $21.50 - $23.00

The focus of theHealthcare Documentation Auditoris the performance of timely and effective reviews to assess documentation and billing accuracy for post and prepayment claims on behalf of Government and Commercial Payers.

Key Responsibilities:

• Review medical records for services billed and validate required documents and information is contained within the records submitted for various service types as required by clients.

• Applying local coverage determination (LCD), national coverage determination (NCD), and commercial payer policy to services in review

• Document and articulate review findings and reference the appropriate policies and rules in the audit platform and as rationale language.

• Working collaboratively with the audit team to identify vulnerabilities and/or cases subject to potential abuse.

• Keep abreast of changes in technology and regulatory issues that may affect our business and clients.

• Suggest ideas that may improve audit workflows.

• Participate in the development of Review Guidelines and meetings as necessary.

• Cross-train in other audit types/focus areas or management teams as applicable

• Maintain required quality and productivity standards.

• Performs other duties as assigned.

Knowledge, Skills, and Abilities Needed:

• Familiarity with insurance programs, particularly the coverage and payment rules, and audit types to validate against orders, units, and signatures.

• Demonstrated knowledge of medical terminology

• Ability to maintain high-quality work while meeting strict deadlines.

• Excellent written and verbal communication skills

• Experience using the following applications is preferred: Word, Excel, and e-mail.

• Must be able to independently use standard office computer technology (e.g., email telephone, copier, etc.) and have experience using a platform to review and document findings.

• Must be able to manage multiple assignments effectively, organize and prioritize workload, problem solve, work independently and with team members.

• Courteous, professional, and respectful attitude

• Flexibility to handle any non-standard situations that may arise
  

Required and Preferred Qualifications:

• High School Diploma or GED is required. Some college is preferred.

• At least two years' experience in adjudicating/examining claims for a Commercial Insurance Company, Tricare, MAC, or organizations performing similar functions, preferred.

• At least five years' experience of provider professional billing, coding, and documentation practices in an outpatient setting, DME, home health, infusion, or hospice to Commercial Insurance Companies, Medicare, Medicaid, Tricare, or organizations performing similar functions, highly desirable.

• Familiarity in quality assurance for internal compliance of billing practices

• Clerical experience dealing with any aspect of: ICD-10, CPT-4 or HCPCS coding.

• Experience using Microsoft Excel and other Microsoft Office applications.

WHAT WE OFFER:

Performant offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, disability coverage options, life insurance coverage, 401(k) savings plans, paid family/parental leave, 11 paid holidays per year, as well as sick time and vacation time off annually. For more information about our benefits package, please refer to our benefits page on our website or ask your Talent Acquisition contact during an interview.

Physical Requirements & Additional Notices:

If working in a hybrid or fully remote setting, access to reliable, secure high-speed Internet at your home office location is required. Proof of such may be required prior to an offer being made. It is the Employee's responsibility to maintain this Internet access at their home office location.

The following is a general summary of the physical demands and requirements of an Office/Clerical/Professional or similar job, whether completed remotely at a home office or in a typical on-site professional office environment. This is not intended to be an exhaustive list of requirements, as physical demands of each individual job may vary.

• Regularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a computer mouse.

• Regularly reads and comprehends information in electronic (computer) or paper form (written/printed).

• Regularly sit/stand 8 or more hours per day.

• Occasionally lift/carry/push/pull up to 10lbs.

Performant is a government contractor and subject to compliance with client contractual and regulatory requirements, including but not limited to, Drug Free Workplace, background requirements, and other clearances (as applicable). As such, the following requirements will or may apply to this position:

• Must submit to, and pass, a pre-hire criminal background check and drug test (applies to all positions). Ability to obtain and maintain client required clearances, as well as pass regular company background and/or drug screenings post-hire, may be required for some positions.

• Some positions may require the total absence of felony and/or misdemeanor convictions. Must not appear on any state/federal debarment or exclusion lists.

• Must complete the Performant Teleworker Agreement upon hire and adhere to the Agreement and all related policies and procedures.

• Other requirements may apply.

All employees and contractors for Performant Financial may and/or will have access to Sensitive, Proprietary, Confidential and/or Public data. As such, all employees and contractors will have ownership and responsibility to report any violations to the Confidentiality and Integrity of Sensitive, Proprietary, Confidential and/or Public data at all times. Violations to Performant's policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination.

Performant is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Performant will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if you believe a reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact Performant's Human Resources team to discuss further.

Our diversity makes Performant unique and strengthens us as an organization to help us better serve our clients. Performant is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law.

THIRD PARTY RECRUITMENT AGENCY SUBMISSIONS ARE NOT ACCEPTED