Description
Professional Healthcare Claims Auditor
Amenity Consulting, LLC, is recruiting for a Professional Healthcare Claims Auditor who will work remotely. The Auditor is responsible for analyzing and auditing professional healthcare claims (CMS1500) to identify issues related to billing, coding, medical necessity, documentation, pricing, and quality. The Auditor is responsible for researching, interpreting, and applying client-specific coding/medical policies and provider-specific contract provisions. The ideal candidate has an extensive background in the payment integrity/payor space and expertise in professional healthcare billing and reimbursement guidelines – with a solid understanding of physician, lab, behavioral health and ancillary coding. Candidate will display strong initiative, be well organized, possess strong problem-solving and communications skills, and be able to work independently, with minimal supervision.
Key Responsibilities:
Ø Reviewing and interpreting professional healthcare claims and medical records to identify issues related to billing, coding, medical necessity, documentation, pricing, and quality.
Ø Drawing conclusions and making logical recommendations based on consideration of client preferences, unique circumstances, and client-specific information, e.g., contract provisions, policies, and financial thresholds.
Ø Supporting audit findings by researching and documenting Amenity and industry-standard rationale, e.g., CPT/ICD coding guidelines, state and federal statutes, and CMS regulations.
Ø Managing sensitive and confidential information.
Ø Effectively utilizing Amenity and client systems to prioritize, execute, document, and report audit activities.
Ø Meeting or exceeding audit-related productivity and quality standards, e.g., hit rate, identifications per hour, accuracy.
Ø Preparing written responses and/or adjudication remarks of audit findings.
Ø Identifying new or expanded auditing concepts and financial recovery opportunities.
Ø Recommending process improvements to enhance communications, operational efficiency, outcome reporting and client satisfaction.
Ø Responsible for reading the acceptable use policy, attending security awareness training, and understanding and following Amenity’s information security and HIPAA privacy and security policies and procedures for handling information in a secure manner.
Requirements
Job Requirements:
Ø Industry-related coding credentials/certifications (CCS, CPC, RHIA, RHIT).
Ø College degree or equivalent.
Ø Proficiency in the use Microsoft Office software, i.e., Outlook, Word, Excel, PowerPoint, and Access; ability to create charts, presentations, graphs, and spreadsheets.
Ø Strong knowledge of professional provider coding methodologies and payment principals, e.g., HCPCS, CPT, ICD9, ICD10, fee schedules, global surgery packages, unbundling, correct coding.
Ø Strong knowledge of medical claims adjudication systems, provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology.
Ø Strong problem-solving abilities.
Ø Strong written and verbal communication skills.
Ø Experience working within the healthcare industry.
Ø Experience working with healthcare claims data.
Ø Ability to manage multiple priorities and deadlines.
Ø Ability to working remotely (with minimal direction) as part of a multi-disciplinary team.
Preferences:
Ø Professional claims auditing experience.
Ø Experience in healthcare claims auditing.
Ø Knowledge of Medicare and Medicaid regulations.
Ø Industry-related investigator credentials/certifications (AHFI, CFE).
Ø Experience in healthcare provider contracting.
Ø Clinical credentials (LPN, RN, PT, OT, RT or other).
Ø A working knowledge of HIPAA Privacy and Security Rules and applicable CMS security requirements.
This is a full-time employee position with health benefits, dental, life, 401k and PTO benefits. Candidates will be required to use Amenity supplied Laptops and must comply with Amenity’s home office security requirements and other security measures. Salary, commensurate with experience and qualifications.
Amenity is a rapidly growing woman-owned business providing healthcare recovery audits, subject matter expertise, and consulting services to health plans, healthcare attorneys, and healthcare fraud and abuse investigators.
Amenity is a flexible and family oriented company with a solid reputation in the healthcare consulting and program integrity industry. For more information about Amenity visit us at www.amenityconsulting.com.
