Audit Clinical Data Coordinator

This is a fully remote position, open to applicants in Pennsylvania.

📋 Description

• Analyze claims data as requested to pinpoint trends in pre- and post-payment audits, as well as claim denials by facility location, payers, and service lines.

• Prepare reports that reflect RAC audits, along with insurance, third-party activities, and claim denials.

• Log audit and claim denial requests, review findings and determinations, and assess logging and tracking processes.

• Identify workflow obstacles and provide recommendations to management and the software vendor.

• Establish and nurture relationships with clients, staff, management, and representatives from insurance/vendors.

• Present audit activity results through written reports and oral presentations to management.

• Complete follow-up and closure of audits.

• Develop educational materials for audit tracking software and deliver ongoing training to staff.

• Review and organize mail received via fax, scanning, and email, ensuring it is assigned to the appropriate work queues.

• Coordinate appeals sent via RightFax and maintain an appeals database.

• Support clinical audit and follow-up teams with write-offs and management of work queues.

• Attend monthly vendor meetings related to insurance/payers to remain informed about policy and billing updates.

⛳️ Requirements

• High School Diploma or GED.

• A minimum of 3 years of experience in a hospital or healthcare administrative secretarial or office management setting.

• Proficient in managing multiple tasks, deadlines, and requests while utilizing effective time-management skills.

• Capability to organize and execute effective reporting and communication to aid management in analyzing RAC and other third-party request activities.

• Computer skills and proficiency in Microsoft Office and other applications for creating and maintaining spreadsheets, databases, and performing word processing tasks.

• Strong planning skills and the ability to maintain composure under pressure while meeting various deadlines.

• Expertise in compiling, summarizing, analyzing complex data, evaluating information, and drawing logical conclusions.

• Preferred: Associate’s Degree.

🏝️ Benefits

• Commitment to equal opportunity employment.

• Day shift schedule.

• Monday to Friday work schedule, from 8:00 AM to 4:30 PM.

• Option for remote work within Pennsylvania.