What are the responsibilities and job description for the Payer Audit Response Analyst position at Summit Health Management, LLC?
Job Description
Essential Job functions:
- Management of Audit Requests
(A/R audit worklists, A/R hold and kick codes, correspondence, payer calls, payer on site visits)
- Responsible to work within various Practice Management Systems any correspondence, legal, RAC, Cert, development letters, ADR letters or any related audits or documentation requests
- Completing claims audit/documentation related worklists within various Practice Management systems assigned and/or correspondence timely
- Take ownership of entire audit request workflow, including follow-up on the outcome and timeliness of response to avoid any unnecessary fines/penalties and subsequent audits
- Coordinate onsite carrier audit reviews (set-up and general training)
- Coordinate documentation/review requests – ensuring timely response and extensions when applicable
- Utilize various Practice Management System to correct/adjust claims accordingly
- Work closely with Reimbursement Specialists, System Integrity and Patient Account Teams to ensure refunds and off sets are appropriately completed and/or posted
- Audit Review/Response
- Prepares formal appeal letters and indicates appeal process with carrier, when applicable based on supporting documentation
- Ensures and coordinates timely processing of refunds when appropriate based on review of documentation available for the audit requests (patient and payer)
- Assist in investigations of insurance sources and investigate and resolve correspondence received from insurance companies
- Ensure proper forms are signed by audit requesters and other parties prior to release of any documentation
- Reviews medical record for proper assignment of diagnoses and procedure codes according to AMA, ICD9/10-CM, CPT, NCCI, LCD, NCD and OIG Guidelines
- Abstracts required data from the medical record, including, but not limited to ICD9/10-CM, CPT, units, sites, modifiers, HCPCS, drugs, supplies, etc.
- Responsible to ensures carrier documentation responses are complete and only included requested information
- Reporting/Trending
- Effectively utilize internal tracking tools for audit activity of all carriers
- Maintain up-to-date logs with frequent summaries of audit activity status for trending purposes by provider, code level, department, specialty, etc.
- Recognize and report problems, errors and discrepancies in medical records, bringing concerns forth to Management and Providers attention
- Ability to identify and report patterns and potential trends timely regarding incoming audit activity alerts Management of potential area of concern/risk
- Utilize practice management system to run reports for tracking & trending purposes
- Develops, maintains and implements tracking and reporting mechanisms related to compliance initiatives and projects – related to audit activity
- Provider/Staff education
- Works with internal Coding Compliance Education Team to provide feedback and areas of needed education
- Works with other key Leads outside of the Department to troubleshoot issues and/or revise workflows to ensure compliance
- Communicates/educates Physicians and other staff on appropriate documentation needs based on audit activity
OTHER:
- Assists Coding teams with various documentation related projects
- Assists on special projects as required
- Perform additional internal audit reviews- identified areas related to audit activity
General Job functions:
The Payer Audit Response Analyst is responsible for working, tracking and coordinating, documentation requests/appeals/refunds related to RAC, CERT and other incoming carrier audit reviews received both via correspondence and/or on-site visits. Such requests are time sensitive and will require immediate documentation retrieval from various Electronic Health Record (EHR) applications, including off-site retrieval and/or coordination from other facilities.
The Payer Audit Response Analyst must exhibit an understanding of coding concepts, AMA, CMS/OIG/Federal/State regulations/guidelines, 1995 & 1997 E&M guidelines, general surgical and diagnostic auditing concepts etc.. Additionally, must exhibit the ability to create and maintain comprehensive tracking /monitoring areas of potential risk and escalating areas of concern to the Director, VP and upper management
Physical Job Requirements:
- Ability to multi-task, organize & prioritize work within any given setting
- Endurance to work long hours on projects
- Ability to process a large amount and various types of data
- Ability to work in confined and/or various workstations
- Ability to work with diverse personalities
- Ability to work remotely
Education, Certification, Computer and Training Requirements:
- Associate’s Degree minimum /Bachelor’s Degree preferred
- Work related experience: 3 years minimum
- A/R experience: 2 year required
- Coding Certification required or must be obtained within 1 year - CPC, CCS-P, CCA, RHIT or RHIA
- Auditing experience: 1 year required/ 2 preferred
- Auditing, Compliance and Billing or Practice Management Certifications – CEMC, CPCO, CPMA, CHC
CCP-P, CPPM, etc. – Preferred
- Proficient use of Microsoft Office Applications (Excel, Word, PowerPoint)
- Proficient use of various EHR applications
Travel
- Travel using personal vehicle is required to various locations (more than 1 mile).
- National travel may be required by other means of transportation other than vehicle
- Travel may be required for extend stay
Benefits*
- A friendly and fast-paced environment working with passionate people
- Outstanding growth opportunities
- Time Off
- Medical, Dental and Vision Insurance
- Short/Long Term Disability, HSA, and Life Insurance
- 401K plan with company matching contribution
- Cash Bonus Programs
- Recognition and rewards programs to recognize successful teams
- Other Perks & Discounts
- Commuter and parking discount program to help you save (using pretax dollars)
- Full Time Benefit Eligible Employees Only
Equal Opportunity Employer
Our Company provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to, and does not discriminate on the basis of, race, color, religion, creed, gender/sex, sexual orientation, gender identity and expression (including transgender status), national origin, ancestry, citizenship status, age, disability, genetic information, marital status, pregnancy, military status, veteran status, or any other characteristic protected by applicable federal, state, and local laws.
Safety Disclaimer
Our Company cares about the safety of our employees and applicants. Our Company does not use chat rooms for job searches or communications. Our Company will never request personal information via informal chat platforms or unsecure email. Our Company will never ask for money or an exchange of money, banking or other personal information prior to the in-person interview. Be aware of potential scams while job seeking. Interviews are conducted at select Our Company locations during regular business hours only. For information on job scams, visit,
https://www.consumer.ftc.gov/JobScams
or file a complaint at https://www.ftccomplaintassistant.gov/
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