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Revenue Cycle Audit Specialist

2 months ago

Lafayette, Louisiana, United States SCP Health Full time


At SCP Health, your contributions are significant. As a member of the SCP Health team, you have the chance to create a positive impact.

Our mission revolves around uniting healthcare facilities and providers to enhance clinical effectiveness.

With a diverse portfolio serving over 8 million patients, 7500 providers, across 30 states and 400 healthcare facilities, SCP Health stands as a frontrunner in clinical practice management across the entire spectrum of care, including emergency medicine, hospital medicine, wellness, telemedicine, intensive care, and ambulatory care.


Why You Will Appreciate Working Here:
- Proven history of delivering excellent work/life balance
- Comprehensive benefits package along with competitive compensation

- Dedication to nurturing an inclusive culture that promotes belonging and empowerment through our core values: collaboration, courage, agility, and respect.


Your Responsibilities:

The Revenue Cycle Audit Specialist will undertake a thorough retrospective analysis of accounts compensated by commercial and/or governmental plans through data mining.

Identify methods to reclaim lost revenue associated with underpayments, enhance reimbursement and cash flow in alignment with federal and state regulations, third-party payer agreements, and UCR protections, which may involve liaising with payers to contest claims.

Act as a liaison among Accounts Receivable, Administration, Operations, Systems, Underpayments team, and payers/plans, coordinating appeal initiatives or resolutions across various departments within the Revenue Cycle.

Provide expertise or general assistance in reviewing, researching, investigating, negotiating, and resolving all types of appeals and grievances.

Examine reimbursement data through both athena IDX Payor Contract Module (PCM) and ad hoc reporting to ensure the accuracy of payments, adjustments, and contract procedures.

Analyze and identify patterns for appeals and grievances; offer feedback to management regarding false positives and genuine underpayment issues.

Collaborate with payer/plans or other representatives to address inaccurate payment issues or non-compliance with contract terms; maintain consistent follow-up while keeping thorough, accurate, and concise records of communication with payers/plans.

Provide insights to the Revenue Cycle regarding enhancement opportunities and appeal campaigns.

Utilize payer portal websites, client patient account systems, and internal technology to continuously validate activity, payment accuracy, and account status.

Assist in maintaining up-to-date information for all contracts in athena IDX Payor Contract Module (PCM), Salesforce database, and Crossmap.
Maintain a comprehensive understanding of reimbursement regulations pertinent to assigned territories and/or plan types.
Ensure that company policies and procedures are current and accurately reflect processes to comply with regulatory requirements.

Qualifications We Seek:
- Bachelor's degree or equivalent professional experience
- 1-3 years of prior experience in Managed Care, medical billing, and/or healthcare reimbursement

- Ability to exercise considerable individual judgment and initiative, relying on experience and judgment to plan and achieve objectives.

- Capacity to perform under moderate stress and pressure while maintaining a positive, professional demeanor in person and through various communication channels.

- Proven ability to deliver quality and timely results while managing multiple projects, demonstrating strong organizational and time management skills.
- Must collaborate effectively with others, exhibiting professional courtesy and exceptional customer relation skills.
- Proficient in clear and effective communication, both verbally and in writing, with all levels of professionals, including executives.
- Competence in problem-solving and analyzing complex data.
- Skill in coordinating projects with diverse groups and individuals.
- Ability to prepare and present effective reports.
- Willingness to adhere to productivity goals and departmental guidelines.
- Advanced understanding of healthcare reimbursement and state and federal insurance laws.
- Proficiency in Microsoft Office products, particularly advanced Excel skills.
To learn more about SCP Health, please visit our website. SCP Health is an Equal Opportunity Employer.