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Reimbursement Variance Auditor

Schumacher Clinical Partners/Lafayette, LA
Job Title: Reimbursement Variance Auditor
Full-time
Job Description:
  • Provide expertise or general support in reviewing, researching, investigating, negotiating and resolving all types of appeals and grievances
  • Perform third party contract reimbursement and utilization review for those policies and procedures related to the definition, identification and collection of denied or incorrect payments and management of denials of payment for the business office
  • Reviews reimbursement data for accuracy of payments, adjustments and contract procedures
  • Verify and compare reimbursement rates with existing fee schedules on file for accuracy
  • Provides input and recommends improvement to existing fee schedules in an effort to maximize reimbursement, improve billing efficiency and reduce accounts receivable aging
  • Provides guidance and/or assists billing representatives in the accounts receivable follow-up process
  • Analyze and identify trends for appeals and grievances
  • Where appropriate, aggregates underpayment trends for expedited processing
  • Provides feedback to manager regarding false positive and true underpayment issues
  • Maintain appropriate fee schedules and request system setup
  • Maintains a high level of accuracy of follow-up while maintaining thorough and concise notes documenting communication with managed care companies
  • Utilizes payer portal websites, client patient account systems, internal technology to continually validate activity, payment accuracy, and account status
  • Communicate with appropriate parties issues, implications and decisions
  • Liaison to billing companies, payers and other necessary parties; responsible for ensuring the correction of discoveries
  • Maintain thorough knowledge of reimbursement regulations related to assigned region
  • Provide feedback to Revenue Cycle related to improvement opportunities and appeal campaigns
  • Ensures that company policies and procedures are current and accurately reflect processes in order to comply with regulatory requirements
  • Authority on impending reimbursement changes and current trends
  • Identifies system or procedural problems creating third party claim rejections
  • Formulates and implements plans for minimizing or eliminating these rejections
  • Assists in the performance contract reviews of third party payer agreements
  • Any other duties deemed necessary by management
Qualifications:
  • Bachelor's Degree
  • Experience: Data Analysis, Auditing, Healthcare Revenue Cycle
Contact:
Apply online at https://goo.gl/BbHx6D.

 Date Posted: 7/7/17