Revenue Integrity Reimbursement Auditor

BHS • Indianapolis, IN

4d • Remote

About The Position

Baptist Health is looking for a Revenue Integrity Reimbursement Auditor to join our team! This is a remote work position that requires residency in KY or IN. The role involves researching denials and/or suspected underpayments from all commercial and governmental payors, including pre-denial audits performed by UPICs or similar entities. The auditor will analyze fee schedules and modeled contracts to determine if Baptist Healthcare System received appropriate reimbursement. This position also performs recovery efforts on reimbursement discrepancies and follows up until resolution. Additionally, the role facilitates the development of strategies at the corporate and facility level to improve reimbursement after identifying trends that negatively impact reimbursement.

Requirements

• Bachelor’s Degree in a related field with at least five years healthcare experience, two of which must be in a revenue cycle related area such as registration, patient accounting, financial services, or managed care.
• In lieu of bachelor’s degree, eight years of healthcare experience required with at least five of those in a revenue cycle related area.
• Knowledge of medical terminology.
• Knowledge of payor reimbursement guidelines (authorization / notification, medical necessity, and timely filing guidelines).
• Knowledge of payor denial appeal / underpayment resolution processes.
• Knowledge of managed care contracts.
• Keen understanding of all audit response requirements and timelines for government audits.

Responsibilities

• Research denials and/or suspected underpayments from all commercial and governmental payors.
• Perform pre-denial audits performed by UPICs or similar entities.
• Analyze fee schedules and modeled contracts to determine if appropriate reimbursement was received.
• Perform recovery efforts on reimbursement discrepancies and follow up until resolution.
• Facilitate development of strategies at the corporate and facility level to improve reimbursement after identifying trends that negatively impact reimbursement.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level