PFS Auditor, Remote

Ambry Genetics

12d•$30 - $35•Remote

About The Position

Patient Financial Services – Auditor, Remote The PFS Auditor works with PFS management, attorneys and claims representatives by reviewing and appealing claims when appropriate to overturn clinical validation and coding denials from Medicare, Medicaid, and other third-party payers. Essential Functions: Conducts SOX reviews by assessing internal controls and auditing billing processes Conducts pre and post billing reviews to ensure quality standards are met prior to billing. Completes assignments in a manner that meets the quality assurance goal of 100% accuracy. Monitors the results of claims audit policies and procedures and reports findings to appropriate leadership. Utilizes Medicare and Contractor guidelines for coverage determinations. Utilizes extensive knowledge of medical terminology, ICD-10-CM, HCPCS Level II to conduct audits. Participate in pre- & post-review meetings, providing support and recommendations for issues presented. Ensure past review recommendations are implemented in current review process. Provides a broad-based knowledge in billing and collections, strong knowledge of industry practice and business principles to ensure department is compliant with all billing practices Works in partnership with other departments for education on patient billing policies and process improvements Other duties as assigned

Requirements

Knowledge of CPT codes, medical terminology, insurance plans, ICD 10 codes
Utilizes Medicare and Contractor guidelines for coverage determinations.
Utilizes extensive knowledge of medical terminology, ICD-10-CM, HCPCS Level II to conduct audits.
Must have ability to adapt to a fast paced, dynamic environment

Nice To Haves

CPC or CPMA preferred
Associates degree preferred

Responsibilities

Conducts SOX reviews by assessing internal controls and auditing billing processes
Conducts pre and post billing reviews to ensure quality standards are met prior to billing.
Completes assignments in a manner that meets the quality assurance goal of 100% accuracy.
Monitors the results of claims audit policies and procedures and reports findings to appropriate leadership.
Utilizes Medicare and Contractor guidelines for coverage determinations.
Utilizes extensive knowledge of medical terminology, ICD-10-CM, HCPCS Level II to conduct audits.
Participate in pre- & post-review meetings, providing support and recommendations for issues presented.
Ensure past review recommendations are implemented in current review process.
Provides a broad-based knowledge in billing and collections, strong knowledge of industry practice and business principles to ensure department is compliant with all billing practices
Works in partnership with other departments for education on patient billing policies and process improvements
Other duties as assigned