Audit Clinical Data Coordinator

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

📋 Description

• Evaluate requested claims data to uncover pre- and post-payment audit trends, as well as claim denial patterns based on facility locations, payers, and service lines.

• Generate reports that summarize RAC audits, insurance and third-party activities, and claim denials.

• Record audit and claim denial requests, assess findings and decisions in the audit tracking database, and review logging and tracking procedures.

• Document all claim denials.

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

• Build and sustain relationships with clients, staff, management, and insurance/vendor representatives.

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

• Conduct follow-up and closure on audits.

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

• Review and organize incoming mail through fax, scanning, and email, directing it to the appropriate work queues.

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

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

• Participate in monthly insurance/payer vendor meetings and keep updated on policy and billing changes.

⛳️ Requirements

• High School Diploma or GED.

• Minimum of 3 years’ experience in a hospital or healthcare administrative secretarial or office management role.

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

• Proficient in organizing and delivering effective reporting and communication to aid management in the analysis of RAC and other third-party request activities.

• Strong computer skills and familiarity with Microsoft Office and other computer applications to create and manage spreadsheets, databases, and perform word processing tasks.

• Exceptional ability to plan and maintain composure under pressure while meeting various deadlines.

• Expertise in compiling, summarizing, and analyzing complex data, assessing information, and making logical conclusions.

• Associate’s Degree is preferred.

🏝️ Benefits

• Equal opportunity employment.

• Day shift schedule.

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

• Remote work opportunity available within Pennsylvania.