Director of Payor Audits

1 month ago


Addison, United States HealthTrackRX Full time
Job DescriptionJob DescriptionWho is HealthTrackRx?

HealthTrackRx is the nation's leading PCR-based infectious disease laboratory By delivering next morning results to healthcare providers nationwide, HealthTrackRx is the premier option for patients and healthcare professionals and in an exciting phase of growth

Job Summary:

The primary role of the Director, Payor Audits, is to manage the company’s overall process for handling SIU and program integrity audits by payors. The Director, Payor Audits, will work closely with the company’s Revenue Cycle Management, Finance & Accounting, Legal, Medical Affairs, Compliance, and other teams to ensure all requests for medical records and supporting documentation are timely submitted and to advocate for the company’s coding of claims for reimbursement of laboratory tests. Primary responsibilities include developing the operations of the Audit team, including managing one incumbent, articulating staffing needs as the company grows, developing workflows and procedures to improve the integrity of the company’s audit process, and reporting on audit status and progress to the company’s senior leadership. This role also offers working closely with the company’s leadership to help analyze audit trends and recommend advocacy opportunities with respect to payor coverage and reimbursement determinations.

Essential Responsibilities/Duties:

  • Work across all teams within the organization to oversee the entire lifecycle of payor audit responses and advocacy.
  • Develop appropriate workflows, processes, and internal tools to optimize audit response function.
  • Engage with payor representatives on audits with significant financial risk to advocate on behalf of company.
  • Manage periodic management reporting package of audit data and status.
  • Work with Revenue Cycle Management team to ensure coding of claims conforms to payor guidance and to incorporate audit findings into billing processes.


Qualifications:

  • Education –
  • Bachelor’s Degree from accredited college or university
  • Competencies/Skills –
  • Demonstrated excellent communication, analytic, organizational, and interpersonal skills
  • Strong, in-depth understanding of both commercial and government program SIU and program integrity audits
  • Excellent process management, workflow development, and cross-functional team project management skills.
  • Analytical ability and strong attention to detail
  • Ability to provide utmost confidentiality in all business-related matters
  • Critical thinker and excellent problem-solving skills
  • Proficient in a Microsoft Office Suite
  • Experience –
  • 6+ years experience performing similar duties in a healthcare provider or facility setting; clinical diagnostic laboratory experience preferred, with at least 2 years of experience in team management.
  • Certifications/Licenses –
  • Certified Professional Coder preferred




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