Charge Auditor, Payor Relations

This is a fully remote position, open to applicants in Florida, +3 more states.

📋 Description

• Create and uphold a centralized repository for fee schedules that encompasses 100% of active contracts.

• Review and maintain fee schedule data for annual regulatory updates, payer-specific adjustments, and bundled payment structures.

• Establish a fee schedule change log and governance process for modifications, escalators, and code updates.

• Conduct reviews and audits of contracted rate tables in comparison to payer agreements, allowables, and internal charge/rate references.

• Identify and document discrepancies between billed amounts, contracted rates, and paid amounts across different payer categories.

• Collaborate with Revenue Cycle Management to reconcile rate tables and address configuration issues.

• Investigate underpayments, coding and billing discrepancies, and rate-table configuration challenges.

• Conduct semi-annual audits of the fee schedule to pinpoint reimbursement leakages.

• Solve rate configuration issues, prevent recurring errors, and recover missed reimbursements.

• Develop and present audit summaries, trend reports, recommendations, monthly dashboards, and semi-annual executive reports.

• Facilitate quarterly business reviews with strategic payors.

• Carry out additional responsibilities as assigned by the Director of Payor Relations.

⛳️ Requirements

• A Bachelor's degree in Business, Finance, Healthcare Administration, or a related discipline is required; equivalent experience may be considered in place of a degree.

• Minimum of 3 years of experience in charge auditing, revenue cycle management, payer contracting, or a related healthcare finance position.

• Proficiency in working with contracted rate tables, fee schedules, and payer reimbursement methods.

• Strong analytical and reconciliation abilities, with a keen skill for identifying variances and root causes within complex rate data.

• Advanced expertise in Excel and other data analysis or business intelligence tools.

• Excellent cross-functional communication skills, enabling effective partnerships with RCM.

• Outstanding organizational abilities, with a proven capacity to develop and maintain governance processes and reporting schedules.

• Detail-oriented individual capable of managing multiple priorities and deadlines autonomously.

• Candidates must be authorized to work for any employer in the U.S.; visa sponsorship for employment is not available.

🏝️ Benefits

• Competitive salary and comprehensive health benefits package.

• Opportunities for professional development and advancement.

• A collaborative work environment with a focus on teamwork and innovation.