Payer Reimbursement Auditor

4 weeks ago

Glen Allen, United States Patient First Full time
The responsibilities of this job include, but are not limited to, the following:
  • Participating with the Payor Relations team and assigned staff in the design of top-level and detailed reporting for the audit process;
  • Vetting the data produced by the Remit Analysis program for accuracy and completeness; making changes to the program as directed;
  • Participating in the analysis of resources required to carry out the audit function;
  • Performing quality assurance audits (compile and analyze data) of all payors' reimbursement on a scheduled basis to ensure contract reimbursement compliance using all programs and tools available;
  • Analyzing data to determine root causes of reimbursement deficiencies and providing recommendations for resolution;
  • Communicating with responsible parties and departments on areas of noncompliance; tracking and following up with all parties until concerns are resolved;
  • Providing appropriate status reporting as directed;
  • Attending various team meetings to address findings, understand contracts, and provide support when necessary;
  • Communicating with payors and other third parties as requested;
  • Working on additional projects as assigned;
  • Operating, using, and maintaining office equipment as trained.
Minimum education requirements include, but are not limited to, the following:
  • High school graduate or equivalent is required; some college education in a related field is preferred;
  • At least two years of Patient First experience required;
  • Strong knowledge of Patient First billing system required;
  • Certified Professional Coder (CPC) certification required; Certified Professional Medical Auditor (CPMA) certification preferred;
  • Five years of previous payor billing experience in a high-volume, high-number-of-payor-contracts environment is preferred;
  • Ability to use Microsoft Excel, create and manipulate pivot tables and other data tools, and create complex formulas required; knowledge of other Microsoft products or data analysis software a plus;
  • Excellent written and verbal communication skills;
  • Must be able to prioritize and handle multiple tasks simultaneously.
  • Self-starter with the ability to work independently and achieve productivity goals.

  • Reimbursement Compliance Auditor

    2 weeks ago

    Glen Allen, Virginia, United States Patient First Full time

    Key Responsibilities: Collaborate with the Payor Relations team and designated personnel to develop comprehensive reporting frameworks for the auditing process;Review and validate the data generated by the Remit Analysis program for precision and thoroughness, implementing modifications as instructed;Engage in assessing the resources necessary to execute the...

  • Reimbursement Compliance Analyst

    2 weeks ago

    Glen Allen, Virginia, United States Patient First Full time

    Key Responsibilities: Collaborate with the Payor Relations team and designated personnel to develop comprehensive and detailed reporting for the auditing process;Review and validate the data generated by the Remit Analysis program for precision and thoroughness, implementing modifications as instructed;Engage in the assessment of resources necessary to...

  • Night Auditor

    3 months ago

    Glen Allen, United States Richmond Marriott Short Pump Full time

    Job DescriptionJob DescriptionYOUR NEXT DESTINATION AWAITSCareers at Commonwealth LodgingWho we are:Top Notch Talent + World Class HospitalityWe take a proactive, hands-on approach to hotel management. Our team boasts extensive experience in all areas of hospitality management.We are a company with a culture that understands relationships and Team First! We...

  • Night Auditor

    2 months ago

    Glen Allen, United States SpringHill Suites by Marriott Richmond NorthGlen Allen Full time

    YOUR NEXT DESTINATION AWAITSCareers at Commonwealth LodgingWho we are:Top Notch Talent + World Class Hospitality We take a proactive, hands-on approach to hotel management. Our team boasts extensive experience in all areas of hospitality management. We are a company with a culture that understands relationships and Team First! We value professionalism,...

  • Occupational Health Insurance Representative

    3 months ago

    Glen Allen, United States Patient First Full time

    The responsibilities of this job include, but are not limited to, the following: Reviewing and addressing processed claims to ensure proper payments are received according to the payers' contract; Reviewing unprocessed claims within the payers' timely filing limits for resubmission of claims for payment; Researching Eligibility of Benefits (EOB) to verify...

  • F/T Night Auditor

    3 months ago

    Glen Mills, United States Onix Hospitality Full time

    Job DescriptionJob DescriptionOffering over 20 years of experience, Onix Hospitality currently owns and manages eight award-winning, top-performing hotels in the Mid-Atlantic region and Florida, operating over 1,000 hotel rooms across its growing portfolio and serving more than half million customers annually. We are currently looking for a Night Auditor to...

  • Outpatient Psychiatric Nurse Practitioner/Physician Assistant

    2 months ago

    Glen Allen, United States SandstoneCare Full time $80 - $85

    Schedule: PRN / Part Time - Some evening availability required Work Environment: Adolescent and Young Adult Outpatient Treatment Center Compensation:$80-$85/hour (based on experience) Benefits:$2500 CME reimbursement per year 401k Program with up to a 5% MatchPTO Accrual A collaborative and supportive community of therapists and team members A company...

  • Senior Accountant | Hybrid | Financial Reporting

    1 month ago

    Glen Allen, United States Incendia Partners Full time

    Job DescriptionJob Description One of the best companies to work for in Richmond is looking for a Senior Accountant. This position drafts external financial reports filed with SEC, financial information for press releases and presentations, and financial compliance reports. Maintains and prepares schedules supporting external reports and disclosures. Reviews...

  • Patient Financial Services Associate

    2 weeks ago

    Glen Cove, New York, United States Northwell Health Full time

    Position Overview The Patient Access Services Representative plays a crucial role in ensuring seamless patient experiences by conducting thorough verification of health insurance coverage. This position involves gathering essential financial and demographic details from discharge planners and external referrals, while consistently demonstrating a commitment...

  • Clinical Speech Therapist PRN

    2 weeks ago

    Glen Mills, Pennsylvania, United States Americare Senior Living of West Tennessee Full time

    Position Overview:As a Clinical Speech Therapist at Americare Senior Living of West Tennessee, you will play a vital role in enhancing the quality of life for our residents. Your expertise will be essential in providing personalized care and support within our community.Location:Americare Senior Living is dedicated to creating a nurturing environment for our...

  • Speech Language Pathologist PRN

    1 month ago

    Glen Mills, United States Erickson Living Full time

    Location: Maris Grove by Erickson Senior Living Maris Grove is a beautiful 87-acre continuing care retirement community located in Glen Mills, Pennsylvania. We’re part of a growing network of communities developed and managed by Erickson Senior Living, a national provider of senior living and health care with campuses in 11 states—and growing. Our...

  • Facility Admissions Coordinator

    1 week ago

    Glen Burnie, Maryland, United States University of Maryland Medical System Full time

    Job SummaryThe University of Maryland Medical System is seeking a highly skilled and detail-oriented Facility Admissions Coordinator to join our team. As a key member of our Patient Access department, you will be responsible for ensuring a seamless and efficient patient registration process, while providing exceptional customer service to our patients and...

  • Facility Admissions Coordinator

    3 months ago

    Glen Burnie, United States University of Maryland Medical System Full time

    Job Description General Summary Under general supervision, performs scheduling, registration, pre-admission processing, wayfinding, and other administrative duties, while adhering to the department specific standards for data entry and patient selection. The additional duties of this role can include verification of insurance benefit eligibility,...

  • Facility Admissions Coordinator- PRN

    4 weeks ago

    Glen Burnie, United States University of Maryland Medical System Full time

    Job DescriptionJob DescriptionCompany DescriptionExperience the highest level of appreciation at UM Baltimore Washington Medical Center — named Top Workplace in the Baltimore area by The Baltimore Sun two years in a row (2019 & 2020); Top Workplace in the USA for 2021!  As part of the acclaimed University of Maryland Medical System, our facility is one of...

  • Facility Admissions Coordinator, Emergency Department, Nights, Part-time

    3 months ago

    Glen Burnie, United States University of Maryland Medical System Full time

    Job DescriptionJob DescriptionCompany DescriptionExperience the highest level of appreciation at UM Baltimore Washington Medical Center — named Top Workplace in the Baltimore area by The Baltimore Sun two years in a row (2019 & 2020); Top Workplace in the USA for 2021!  As part of the acclaimed University of Maryland Medical System, our facility is one of...

  • Facility Admissions Coordinator

    2 months ago

    Glen Burnie, United States University of Maryland Medical System Full time

    Job DescriptionJob DescriptionCompany DescriptionExperience the highest level of appreciation at UM Baltimore Washington Medical Center — named Top Workplace in the Baltimore area by The Baltimore Sun two years in a row (2019 & 2020); Top Workplace in the USA for 2021!  As part of the acclaimed University of Maryland Medical System, our facility is one of...

  • Nurse Case Manager RN Primary Care

    1 month ago

    Glen Burnie, United States University of Maryland Medical System Full time

    Job Description Shift Schedule: Monday - Friday 8:00AM - 4:30PM Location: Baltimore Washington Medical Center General Summary Under supervision of the Case Management Leadership, will manage and oversee the comprehensive assessment, planning, implementation, monitoring, and overall evaluation of individual patient needs. A Case Manager assists in identifying...

  • Nurse Case Manager

    1 month ago

    Glen Burnie, United States University of Maryland Medical System Full time

    Job DescriptionJob DescriptionCompany DescriptionExperience the highest level of appreciation at UM Baltimore Washington Medical Center — named Top Workplace in the Baltimore area by The Baltimore Sun two years in a row (2019 & 2020); Top Workplace in the USA for 2021!  As part of the acclaimed University of Maryland Medical System, our facility is one of...