Job Description:
The Compliance Auditor position is responsible for the accurate and timely audit of underpaid claims, resubmission/appeal process and collections of third-party accounts. The Auditor ensures collection of assigned accounts within specific payer timelines by following up appropriately to resolve issues that may increase the days of outstanding revenue.
Responsibilities:
- Ensures that accurate and complete information appears on appeal letters.
- Prepares and submits all manual, appeals to non-government third-party payers in a timely manner requesting hospital contracted reimbursement rate.
- Identifies consistent billing errors or trends and recommends solutions to the director in a timely fashion.
- Ensures that all appeal notes and follow-up and collection activity is documented with clarity and accuracy in customer’s patient accounting system and internal systems.
- Follows up on the status of all outstanding appealed accounts to make sure that every effort is made to collect the account within specific payer timelines.
- Interacts effectively and maintains good rapport with assigned payers to resolve billing problems as efficiently as possible.
- Performs job responsibilities in an ethical, effective and professional manner.
- Reports potential fraud and abuse violations to management.
- Understands supports and consistently follows policies and procedures.
- Prepares issues logs and submits to the director.
- Represents and promotes the company and its high standards.
- At times assists unit staff members with problem research and resolution.
- Performs other duties as required in relation to function.
Education:
Associate’s degree in healthcare or related field, with a minimum of 3 years of experience.
Skills:
- Ability to communicate well with internal and external contacts.
- Working knowledge of computer programs including Excel, Word and general processing systems.
- Knowledge of coding conventions i.e. HCPC, CPT4, etc. as used in healthcare billing.
Apply:
Please email your resumes with salary requirements to hr@nhpn.net or fax us at 610.230.0903.