Revenue Integrity Reimbursement Auditor

Baptist Health; Charlestown (IN); Remote; USD 80,000 - 100,000; Full time

Job summary

A healthcare provider is seeking a Revenue Integrity Reimbursement Auditor for a remote position. Responsibilities include researching payor denials, performing recovery efforts, and developing strategies to improve reimbursement. Candidates should have a Bachelor's degree and experience in revenue cycle management, along with knowledge of medical terminology and payor reimbursement guidelines.

Qualifications

• Five years of healthcare experience with two years in a revenue cycle related area.
• In lieu of degree, eight years of healthcare experience is acceptable.
• Knowledge of payor denial appeal processes and managed care contracts is required.

Responsibilities

• Research denials and payment variances from payors.
• Perform recovery efforts on reimbursement discrepancies.
• Develop strategies to improve reimbursement.

Skills

Knowledge of medical terminology

Understanding of payor reimbursement guidelines

Experience in revenue cycle management

Ability to analyze payor contract terms

Education

Bachelor's degree

Job description

Overview

Baptist Health is looking for a Revenue Integrity Reimbursement Auditor to join their team. This is a remote work position that requires residency in KY or IN.

Responsibilities

Research denials and/or suspected payment variances from all commercial and governmental payors, including audits RACs or similar Medicare and Medicaid programs. Analyze Negotiated Payor Contract Terms and Payment Appendices, Provider Manuals, and Provider Policies / Bulletins, and understand modeled expected reimbursement methodology as it applies to the services rendered to Baptist Health patients.

Performs recovery efforts on reimbursement discrepancies by monitoring the payor dispute / appeal, escalation to the Director / Manager, or Managed Care until resolution is achieved. Facilitates development of strategies after trends which negatively impact reimbursement are identified both at the corporate and/or facility level in order to improve reimbursement for Baptist Health System.

Minimum Education, Experience, Training and Licensures Required

• Bachelor's degree
• Five years healthcare experience with two years in a revenue cycle related area such as registration, patient financial services, or managed care.
• In lieu of bachelor's degree, eight years of healthcare experience required including five years in one of the revenue cycle related areas listed above.
• Requires knowledge of medical terminology; payor reimbursement guidelines (authorization / notification, medical necessity, and timely filing guidelines); payor denial appeal / payment variance resolution processes; and managed care contracts.
• Individuals working with payor audits must have a keen understanding of all audit response requirements and timelines.

Baptist Health is an Equal Employment Opportunity employer.