Healthcare Documentation Auditor

Performant Corp • Plantation, FL

5d • $19 - $21 • Remote

About The Position

The focus of the Healthcare Documentation Auditor is the performance of timely and effective reviews to assess documentation and billing accuracy for post and prepayment claims on behalf of Government and Commercial Payers.

Requirements

• Familiarity with insurance programs, particularly the coverage and payment rules, and audit types to validate against orders, units, and signatures.
• Demonstrated knowledge of medical terminology
• Ability to maintain high-quality work while meeting strict deadlines.
• Excellent written and verbal communication skills
• Experience using the following applications is preferred: Word, Excel, and e-mail.
• Must be able to independently use standard office computer technology (e.g., email telephone, copier, etc.) and have experience using a platform to review and document findings.
• Must be able to manage multiple assignments effectively, organize and prioritize workload, problem solve, work independently and with team members.
• Courteous, professional, and respectful attitude
• Flexibility to handle any non-standard situations that may arise
• High School Diploma or GED is required.
• At least two years’ experience in adjudicating/examining claims for a Commercial Insurance Company, Tricare, MAC, or organizations performing similar functions, preferred.
• Familiarity in quality assurance for internal compliance of billing practices
• Clerical experience dealing with any aspect of: ICD-10, CPT-4 or HCPCS coding.
• Experience using Microsoft Excel and other Microsoft Office applications.
• Must submit to, and pass, a pre-hire criminal background check and drug test (applies to all positions).
• Must not appear on any state/federal debarment or exclusion lists.
• Must complete the Machinify Teleworker Agreement upon hire and adhere to the Agreement and all related policies and procedures.

Nice To Haves

• Some college is preferred.
• At least five years’ experience of provider professional billing, coding, and documentation practices in an outpatient setting, DME, home health, infusion, or hospice to Commercial Insurance Companies, Medicare, Medicaid, Tricare, or organizations performing similar functions, highly desirable.

Responsibilities

• Review medical records for services billed and validate required documents and information is contained within the records submitted for various service types as required by clients.
• Applying local coverage determination (LCD), national coverage determination (NCD), and commercial payer policy to services in review
• Document and articulate review findings and reference the appropriate policies and rules in the audit platform and as rationale language.
• Working collaboratively with the audit team to identify vulnerabilities and/or cases subject to potential abuse.
• Keep abreast of changes in technology and regulatory issues that may affect our business and clients.
• Suggest ideas that may improve audit workflows.
• Participate in the development of Review Guidelines and meetings as necessary.
• Cross-train in other audit types/focus areas or management teams as applicable
• Maintain required quality and productivity standards.
• Performs other duties as assigned.

Benefits

• Machinify offers a wide range of benefits to help support a healthy work/life balance.
• These benefits include medical, dental, vision, HSA/FSA options, life insurance coverage, 401(k) savings plans, family/parental leave, paid holidays, as well as paid time off annually.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 1,001-5,000 employees