Audit & Appeals Specialist -Medical Claims Position Available In Montgomery, Pennsylvania

Audit & Appeals Specialist -Medical Claims 4.3 4.3 out of 5 stars 521 Stump Road, North Wales, PA 19454 Overview We are seeking a detail-oriented and analytical Audit Specialist to join our team. The ideal candidate will possess strong clinical acumen and a thorough understanding of medicare policies and billing requirements. As an Audit Specialist, you will play a critical role in ensuring the accuracy and integrity of medical records, compliance with regulations, and the effectiveness of internal controls. This position requires a proactive approach to risk management and the ability to communicate findings effectively. This position is responsible for the coordination of external reviews / audits, including but not limited to Medicare, Medicaid, commercial insurance or successor organizations; Medicare and/or Medicaid pre and / or post documentation, commercial insurance medical records request/reviews. This includes but is not limited to establishing workflows, policies and procedures, software analysis and maintenance and implementation of processes and communication plans for the facility’s interactions with third party auditors including but not limited to pre and post payment Medicare, Medicaid and commercial insurances reviews to ensure timely completion or review/audit documentation requests. This position is responsible for the oversight of all pre and post payment audit functions, medical documentation requests and is responsible for maintaining a tracking system for all audits/requests activity throughout all levels of appeals. The Audit Specialist is responsible for the writing and submission of basic payer appeal, including review and submission of supporting documentation and regulations The Audit Specialist will analyze review/audit findings, denials to identify problems in processes, get the information to key people to evaluate, including preparing and sending reports weekly to Chief Compliance Officer; Revenue Cycle Manager; Referral Management and others as identified/assigned

Experience Required:

Must have clinical or patient accounting background with fundamental knowledge of the Revenue Cycle Process, which includes patient access, case management/utilization review, patient accounting, billing and coding compliance. In-depth familiarity with third party billing requirements, governmental regulations and billing documentation compliance requirements pertaining to medical equipment & supplies reimbursement. Minimum of 1 years’ experience coordinating third party audit review cycle from receipt of documentation request through finalizing results with payers and/or governmental agencies Experience writing and submitting basic payer appeal, including review and submission of supporting documentation and regulations

Job Type:

Full-time Pay:

$65,000.00 – $90,000.00 per year

Benefits:

401(k) 401(k) matching Dental insurance Flexible spending account Health insurance Health savings account Life insurance Paid time off Vision insurance Application Question(s): What is your salary requirement?

Experience:

Medicare Audits:

1 year (Preferred) Documentation review: 1 year (Preferred) Medical billing: 1 year (Preferred)

Work Location:

In person