Reimbursement Auditor, Full-Time

Community Hospital•Grand Junction, CO

2d•Onsite

About The Position

The Compliance Reimbursement Auditor is a full-time position responsible for ensuring proper reimbursement for Oncology services. This role involves coordinating with internal departments and external facilities, reviewing payments, managing denials and appeals, and staying updated on coding practices. The auditor will act as a subject matter expert for research billing compliance, collaborate with the Financial Services team, and define processes for quality and efficiency in billing and reimbursement.

Requirements

High school diploma or equivalent
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 proper reimbursement from payers
Review all Oncology/Research related denials and coordinate appeals with appropriate Business Office Team/s
Review and update current HCPCS codes as they are related to Oncology
Participate in hospital-wide coding and charge master meetings
Act as a Subject Matter Expert and perform internal monitoring to ensure research billing compliance
Collaborate closely with the Financial Services team for final coding and billing
Provide CPT codes for all study procedures billable to sponsor, patient, and/or Insurance
Manage and communicate Medicare Coverage Analysis for GVO Clinical Trials
Define and improve processes to ensure quality and efficiency
Collaborate with the Research Team for Sponsor Billing
Implement policies and processes for internal and external workflows to ensure compliant, quality, and efficient practices related to Oncology and Research Billing and Reimbursement
Act as a liaison for any Oncology or Research billing questions, changes and/or concerns
Escalate 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