Auditor, Zero Balance

CorroHealth • NV-Remote, NV

3d • Onsite

About The Position

Healthcare Auditors develop contract models for analysis and identify potential insurance reimbursement issues through extensive reviews of hospital claim data and related documents. Auditors also contribute to our knowledge base by conducting research on reimbursement risk areas, reviewing data and processes for quality control, and providing feedback for areas of improvement.

Requirements

• High School Diploma or equivalent required
• Minimum of 2 years of experience working with large sets of (healthcare) data
• Minimum of 2 years of experience in areas of research and analysis
• Minimum of 2 years of experience with managed care contracts (government and commercial) and hospital reimbursement
• Minimum of 2 years of experience working with inpatient claims
• Minimum of 1 year of experience with contract modeling
• Basic Excel skills, including knowledge of simple formulas (SUM, AVERAGE), basic pivot tables and ability to filter and sort data sets
• Strong verbal and written communication skills
• Ability to translate complex contract language and healthcare data into actionable information and insights
• Ability to work independently to solve problems and recommend technical solutions (ex. provide calculation/formula to price)
• Strong organization skills and attention to detail

Responsibilities

• Create and update audit plans, including outlining potential risk areas of a hospital-payer contract based on reimbursement structure and how to manually identify within the data.
• Model and create/update pricing documents based on hospital contracts to calculate expected payments with contract language such as percentage of charge, per diems, MSDRG, outlier and/or stoploss, implants, drugs.
• Review insurance payments, research applicable sources (contracts, state and federal legislation, insurance payer policies, medical records, etc.) to determine if payment is correct and make recommendations on appropriate next steps.
• Identify contractual and clinical risk areas from commercial and government payors (e.g., Medicare, Medicaid).
• Conduct review of zero-balance hospital accounts to identify underpaid inpatient claims.
• Present clear documentation of process, findings, and results of audits.
• Make recommendations to improve internal processes and external client contracts/processes.
• Work with data analyst team to build and validate pricing models.
• Other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED