PCR Audit Specialist

Svdpnky; Richardson (TX); On-site; USD 60,000 - 95,000; Full time

Job summary

Empower is seeking a seasoned Billing Auditor to join our healthcare administration team in Richardson, TX. The role focuses on pre-claim review, auditing medical records, and ensuring accurate billing through QA processes.

You will work with Billing and Compliance teams, monitor billed and unbilled accounts in EMR, and drive quality assurance across the revenue cycle. Leadership experience in training and guiding staff is preferred.

Qualifications

• In-depth knowledge of healthcare billing processes and regulations.
• Detail oriented with strong organizational and analytical capabilities.
• Excellent communication and collaboration with cross-functional teams.

Responsibilities

• Accountable for billing audits and clinical quality assurance audits.
• Ensures all functions are compliant with federal, state, and local laws.
• Uses EMR or other systems to monitor status of billed and unbilled accounts.
• Completes audit workflow in EMR.
• Collaborates with Billing and Compliance teams.
• Maintains proper controls for accuracy and timeliness of billing.
• Contributes to special projects and suggests process improvements.
• Escalates issues to Supervisor promptly.
• Interacts with various branch personnel to achieve outcomes.
• Supports Empower Services and Revenue Cycle department goals.

Skills

Healthcare billing

Detail oriented

Analytical skills

Problem solving

Communication

Interpersonal skills

Education

Associate degree in related field or equivalent experience

Job description

At Empower, we are proud to serve as a one-stop-shop business partner for healthcare organizations to support their administrative and employer needs. We strive to be more than a workplace, but also a community, where every voice is heard, and every team member is valued. Our team is driven by a shared mission to create a positive impact on healthcare organizations and the lives they touch. Join our team today to be part of our mission!

GENERAL PURPOSE:

Responsible for the pre-claim review process including auditing components of medical records but not limited to performing the billing audit and performing quality assurance audits to ensure accurate billing.

ESSENTIAL FUNCTIONS:

• Accountable for billing audits and clinical quality assurance audits.
• Ensures all functions are completed in compliance with federal, state, and local laws.
• Utilizes EMR or other systems to monitor status of billed and unbilled accounts.
• Completes audit workflow in EMR.
• Provides collaboration with the Billing team and Compliance teams.
• Ensures proper controls are adhered to for accuracy and timeliness of billing.
• Actively contribute to special projects and offers feedback/suggestion to improve process.
• Escalates issues/problems timely to Supervisor.
• Interacts with a variety of personnel in the branch to achieve outcomes.
• Contributes to Empower Services and Revenue Cycle department goals by accomplishing related duties as required.
• Additional duties as assigned by supervisor and leadership.

Minimum Education & Experience Requirements:

• Associate degree in related field or equivalent work experience.
• Minimum five (5) years healthcare billing experience inclusive of managed care or
• One (1) year in a leadership role providing training, support, and direction.

Knowledge, Skills & Abilities Required:

• In-depth knowledge of healthcare industry billing.
• Detail oriented with strong organization, analytical and problem-solving skills.
• Proficient with software and systems.
• Excellent communication and interpersonal skills.
• Occasional same-day travel for meetings and conferences.

Working Conditions & Physical Effort:

• Work is normally performed in a typical interior/office work environment.
• Ability to work flexible schedule and/or evening hours as needed.
• Sits most of the time; infrequent to occasional walking or standing.
• Ability to sit in front of CPU for long periods of time.
• Ability to travel as needed.
• Physical activity is sedentary and may require occasional lifting or carrying up to 10 lbs.

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities.

• Equal Employment Opportunity Policy
• It is the policy and practice of the company to abide by all anti-discrimination laws provided for by federal, state, and local statutes.