Reimbursement Auditor, Full-Time

Community Hospital•Grand Junction, CO

3d•$27 - $31•Onsite

About The Position

The Compliance Reimbursement Auditor will be responsible for ensuring appropriate reimbursement for Oncology services by coordinating with internal departments and external facilities, reviewing payments, and managing denials and appeals. This role involves updating HCPCS codes, participating in coding and charge master meetings, and serving as a Subject Matter Expert for research billing compliance. The auditor will collaborate closely with the Financial Services team, provide CPT codes for study procedures, manage Medicare Coverage Analysis for clinical trials, and define/improve processes for quality and efficiency. Additionally, the position involves collaboration with the Research Team for sponsor billing, implementing policies for internal and external workflows, and acting as a liaison for all Oncology or Research billing inquiries and concerns. The role also requires verifying if clinical research studies qualify as per Medicare Clinical Trial Policy.

Requirements

High school diploma or equivalent; Bachelor’s degree in Science, healthcare or related field preferred.
At least 5 years of inpatient/outpatient coding experience OR equivalent combination of education and experience.
Certification in one of the following organizations is required: AHIMA, AAPC (RHIT and/or CCS,)
ACRP / SOCRA certification within 6 months of being eligible (SOCRA is preferred)

Nice To Haves

Bachelor’s degree in Science, healthcare or related field preferred.
SOCRA certification is preferred.

Responsibilities

Coordinate with internal departments and external facilities to determine the appropriate payor for services
Review payments received for Oncology services to ensure we are receiving proper reimbursement from payers
Review all Oncology/Research related denials and coordinate appeals with appropriate Business Office Team/s
Ability to review and update current HCPCS codes as they are related to Oncology
Participation in hospital wide coding and charge master meetings
Subject Matter Expert and internal Monitoring to ensure research billing compliance
Collaborating closely with the Financial Services team who will be responsible for completing final coding and billing.
Providing CPT codes for all study procedures that are billable to sponsor, patient, and/or Insurance
Management and Communication of Medicare Coverage Analysis for GVO Clinical Trials
Defining and improving processes to ensure quality and efficiency
Collaboration with Research Team for Sponsor Billing
Involvement in implementing policies and processes for internal and external workflows to ensure complaint, quality and efficient practices related to Oncology and Research Billing and Reimbursement
Acts as a liaison for any Oncology or Research billing questions, changes and/or concerns.
Escalates Oncology or Research billing questions, changes and/or concerns appropriately.
Verify determinations of whether proposed clinical research studies are a qualifying clinical trial as defined by Medicare Clinical Trial Policy