Payment Audit Specialist

• Complete Contract Underpayment work lists as assigned, focusing initially on high dollar return and low hanging fruit variances. Contact appropriate payer representatives to provide evidence of alleged underpayments, and follow to resolution.
• Updates status of assigned accounts in Claim Tracking software, including copious notes regarding payer response (or lack thereof). Brings issues and bottlenecks in underpayment recovery process to System Director for escalation as needed.
• Works with Reimbursement Team (and others as mentioned above) to fine tune contract rules in the Modeling software, to eliminate unnecessary variance amounts.
• Works with Revenue Cycle Team regarding issues identified as posting errors, incorrect payer coding, and other transactional issues.
• Assists the Reimbursement Team as requested in items related to reimbursement, revenue cycle, coding and similar/related issues.
• Generate/run variance reports as needed, or as requested by Director.

• Knowledge of the revenue cycle process
• Knowledge of Medicare and Medicaid regulations
• Attention to detail and ability to push through obstacles
• Ability to probe/investigate and find discrepancies, errors, omissions and bring to resolution
• Excellent critical thinking skills.
• Good spreadsheet and other computer skills
• Ability to communicate with third-party payers/auditors
• Ability to work independently in a time-oriented environment.
• Excellent skills in managing workload timely and efficiently
• Works well within a team environment, even when team is geographically distributed

Appalachian Regional Healthcare