Insurance Reimbursement Auditor

4 weeks ago

Louisville, United States CareerBuilder Full time

WE ARE HIRING

Location: 250 E Liberty Street Louisville, KY 40202

About UofL HealthUofL Health is a fully integrated regional academic health system with nine hospitals, four medical centers, Brown Cancer Center, Eye Institute, nearly 200 physician practice locations, and more than 1,000 providers in Louisville and the surrounding counties, including southern Indiana. Additional access to UofL Health is provided through a partnership with Carroll County Memorial Hospital.

Affiliated with the University of Louisville School of Medicine, UofL Health is committed to providing patients with access to the most advanced care available. This includes clinical trials, collaboration on research and the development of new technologies to both save and improve lives. With more than 13,000 team members physicians, surgeons, nurses, pharmacists and other highly-skilled health care professionals, UofL Health is focused on one mission: to transform the health of communities we serve through compassionate, innovative, patient-centered care. For more information on UofL Health, go to www.uoflhealth.org.

Job Summary: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.

Minimum Education and Experience 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

Knowledge, Skills, and Abilities 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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