Post Payment Audit Specialist, Patient Financial Services

Hudson Hospital • Brainerd, MN

2d • $26 - $39

About The Position

HealthPartners is seeking a Patient Financial Services Post Payment Audit Specialist to support compliant and timely management of audit and denial-related activities. The role collaborates with internal departments, payers, and external vendors on Recovery Audit Contractor (RAC) audits, Additional Documentation Requests (ADR), Comprehensive Error Rate Testing (CERT), and other regulatory or payer-driven requests. It ensures documentation is accurately compiled, submitted, and tracked within established filing deadlines and that incoming requests received through mail, electronic portals, and payer communications are prioritized and resolved appropriately.

The specialist supports medical record review and appeal-documentation development in partnership with Utilization Management, Coding, Health Information Management, Patient Financial Services, Compliance, Finance, and Audit teams. The work supports accurate determinations of level of care, claim status, and reimbursement outcomes. The position also identifies trends, root causes, and process gaps affecting revenue integrity and works with operational stakeholders on corrective actions, education, and process improvement. The work is fast-paced and involves managing multilevel appeal processes, applying critical thinking and judgment, and maintaining knowledge of Medicare guidelines and regulatory requirements.

The schedule is Monday through Friday, either 7:00 a.m. to 3:30 p.m. or 8:00 a.m. to 4:30 p.m. HealthPartners describes itself as a nonprofit integrated health care organization and an Equal Opportunity Employer. Benefits are available for eligible positions and include medical and dental insurance, a retirement program, time away from work, insurance options, tuition reimbursement, an employee assistance program, and other offerings.

Requirements

• 3–5 years of healthcare revenue cycle experience in billing, coding, audits, or denials.
• Experience with payer audits, appeals, and regulatory requirements such as RAC, ADR, and CERT.
• Strong knowledge of revenue cycle operations, payer guidelines, and reimbursement methodologies.
• Working knowledge of Medicare and Medicaid regulations, including audit and appeal processes.
• Ability to interpret clinical documentation, coding, and billing requirements.
• Effective written and verbal communication skills, including the ability to develop compelling appeal letters.
• Ability to manage multiple priorities in a fast-paced, deadline-driven environment.
• Proficiency with electronic medical record systems such as Epic, payer portals, and Microsoft Office applications.
• Strong collaboration skills and ability to influence cross-functional stakeholders to resolve issues.
• High attention to detail and commitment to accuracy and compliance.

Nice To Haves

• Bachelor’s degree in Healthcare Administration, Business, Finance, Nursing, or a related field, or an equivalent combination of education and relevant experience.
• Advanced experience with RAC, ADR, CERT, and complex appeals.
• HFMA Certified Revenue Cycle Representative (CRCR).
• Clinical licensure, such as LPN, preferred for roles involving medical necessity review.
• Advanced data analysis and reporting skills, including interpreting denial trends, audit findings, and financial impact to support revenue integrity initiatives and leadership decision-making.
• Strong proficiency in payer policy interpretation and contract language, with the ability to translate complex regulatory and reimbursement requirements into effective appeal strategies and operations.

Responsibilities

• Collaborate with internal departments, payers, and external vendors to manage audits and denial-related activities, including RAC audits, ADRs, CERT, and other regulatory or payer-driven requests.
• Compile, submit, and track documentation accurately within established filing deadlines.
• Monitor and manage incoming requests received through mail, electronic portals, and payer communications, prioritizing and resolving them appropriately.
• Support medical record review and development of appeal documentation in partnership with relevant internal teams.
• Contribute to accurate determinations of level of care, claim status, and reimbursement outcomes.
• Identify denial trends, root causes, and systemic or process gaps affecting revenue integrity and reimbursement.
• Collaborate with operational stakeholders on corrective actions, education, and process improvement initiatives to reduce denials and audit risk.
• Maintain accurate documentation of actions taken in applicable systems.
• Review and understand insurance correspondence, including remittance advice, explanations of benefits, and denial letters.
• Make necessary adjustments and write off patient account charges and/or balances.

Benefits

• Medical insurance
• Dental insurance
• Retirement program
• Time away from work
• Insurance options
• Tuition reimbursement
• Employee assistance program
• Comprehensive benefits supporting health, time off, retirement planning, and continuous learning opportunities

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed