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UofL Health is a fully integrated academic health system focused on delivering patient-centered care.
Insurance Reimbursement Auditor
Location
United States
Posted
18 days ago
Salary
0
Seniority
Mid Level
No structured requirement data.
Job Description
Insurance Reimbursement Auditor
UofL Health
Role Description WE ARE HIRING! Location: 100% Remote Shift: First Shift Primarily responsible for the review and follow up on paid insurance claims (including $0.00 pay) and payor recoupments to successfully determine if reimbursement is accurate according to current contracted rates and follow up with payers on outstanding monies due for services rendered to a patient. This position will provide “root cause” analysis and reporting of revenue opportunities to ensure appropriate reimbursement. - Perform thorough research of paid claims (including $0.00 pay) for appropriate follow up with payer. - Provide detailed analysis of findings and payer trends. - Review claim remittances to determine reimbursement rates and methodologies used by the payer when processing the claim. - Identify opportunities with underpayment or contract language that is determinant to reimbursement and report findings to leadership. - Perform extensive review of high dollar accounts that are subject to alternative reimbursement terms to validate payments are in accordance with contracted rates. - Responsible for reviewing and understanding explanation of benefits/remittance advice from third-party payers. - Process and review incoming correspondence from payers related to underpayment or high dollar/outlier payment discrepancies. - Audit, research accounts, payment posting, and contractuals to confirm the accuracy of the balance, financial class, and follow up schedule on the account. - Phone contact with patient, physician office, attorney, etc. for additional information to provide payer in order to process claim in accordance with contracted rates. - Communicate payment discrepancies to payer specific provider representatives via email, phone, or scheduled in-person meetings. - Work with reimbursement and contract modeling team members to verify contracted rates are properly calculated with contract modeling system. - Maintain regular contact with Managed Care & Contracting management team to ensure all new contract agreements/updated rates are received timely and effective dates for new rates are communicated to the appropriate Revenue Cycle teams. - Prepare and submit letters, emails, faxes, online inquiries, appeals, and adjustments. - Document all follow up efforts in a clear and concise manner into the AR system. - Work assigned accounts as directed while reaching daily productivity goals. - Complete tasks by deadline provided by leadership. - Participate in system testing and training. - Attend seminars as requested. - Other duties as assigned. Qualifications - High School Diploma or GED - 2-3 years of billing, insurance follow-up or insurance payor experience - Experience performing account resolution with third-party payors is preferred - Experience in working with ICD-10, revenue codes, CPT-4 and HCPCS - Moderate computer proficiency including working knowledge of MS Excel, Word and Outlook Requirements - Ability to read and interpret documents, i.e. contracts, claims, instructions, policies and procedures in written (in English) form. - Ability to calculate rates using mathematical skills. - Ability to define problems, collect data, and establish facts to execute sound financial decisions in regard to patient account(s). - Must have detailed knowledge of the uniform bill guidelines. - Ability to be persistent in the follow up of underpaid or partially paid claims in a timely manner. - Ability to review, comprehend, and discuss HCFA billing with Insurance or Government agencies. - Knowledge of general insurance requirements. - Experience working directly with EOBs, contractual adjustments, and payer contracts. - General computer knowledge and working with electronic filing systems. - Ability to communicate verbally and in writing with professionalism. - Organizational and documentation skills to ensure timely follow-up and accurate record keeping. - Ability to meet productivity expectations. - Strong team player. - Strong self-motivation to achieve goals.
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