Revenue Integrity Reimbursement Auditor

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

📋 Description

• Investigate denials and potential underpayments from both commercial and governmental payors.

• Conduct pre-denial audits through UPICs or equivalent organizations.

• Evaluate fee schedules and modeled contracts to assess if Baptist Healthcare System received proper reimbursement.

• Execute recovery initiatives for reimbursement discrepancies and ensure follow-up until resolution.

• Support the creation of corporate and facility-level strategies aimed at enhancing reimbursement.

• Detect patterns that adversely affect reimbursement.

⛳️ Requirements

• Bachelor’s Degree in a relevant field coupled with a minimum of five years of experience in healthcare.

• At least two years of experience in a revenue cycle-related field such as registration, patient accounting, financial services, or managed care.

• Alternatively, eight years of healthcare experience is acceptable, including at least five years in a revenue cycle-related area, in place of a bachelor’s degree.

• Familiarity with medical terminology.

• Understanding of payor reimbursement guidelines, which encompass authorization/notification, medical necessity, and timely filing standards.

• Insight into payor denial appeal and underpayment resolution procedures.

• Knowledge of managed care contracts.

• Strong comprehension of audit response requirements and timelines associated with government audits.

• Resident of KY or IN.

• Must successfully complete post-offer, pre-employment drug testing.

🏝️ Benefits

• Remote work opportunity.

• Committed to being an Equal Employment Opportunity employer.

• Maintains a drug-free workplace.

• Requires post-offer, pre-employment drug testing.