Managed Care Auditor

Description

The Managed Care Contract Auditor is responsible for auditing the accuracy of payments made by the Managed Care companies for services rendered at the addition the position is responsible for reporting results in an effort to improve internal processes and communicate payment problems to Managed Care and the Business Office.

Responsibilities

1. Audit Analysis and Reporting

• Audits report from decision support system to compare expected payments with actual payments. Compares contract terms to payment to determine appropriate billing timeliness and accuracy of payment.
• Specifies produces and analyzes a standard set of utilization and medical expense reports to support the assessment and cost effectiveness of managed care contracts. Maintains report showing audit results and communicates results of audits to Business Office and Managed Care Departments.
• Identifies trends related to specific payers and / or internal process problems that negatively impact hospital cash flow.
• Performs audits of inaccurately adjudicated accounts and reconciles to the contract and corresponding explanation of benefits.

2. Collaboration and Partnership

3. Other Duties As Assigned

#CB

Qualifications

Key Skills

Auditing,Time Management,ICD-10,Accounting,Component evaluation,Workers' Compensation Law,SOX,Microsoft Excel,CPT Coding,Internal Audits,Medicare,Bookkeeping

Employment Type : Full Time

Experience : years

Vacancy : 1