Revenue Integrity Reimbursement Auditor

Summary

Job Description:

Baptist Health is looking for a Revenue Integrity Reimbursement Auditor to join their team. This is a remote work position that requires residency in KY or IN

Research denials and/or suspected payment variances from all commercial and governmental payors,including audits RACs or similar Medicare and Medicaid programs. Analyzes Negotiated Payor ContractTerms and Payment Appendices, Provider Manuals, and Provider Policies / Bulletins, and understandsmodeled expected reimbursement methodology as it applies to the services rendered to Baptist Health patients.

Performs recovery efforts on reimbursement discrepancies monitoring the payor dispute / appeal,escalation to the Director / Manager, or Managed Care until resolution is achieved. Facilitates developmentof strategies after trends which negatively impact reimbursement are identified both at the corporate and/orfacility level in order to improve reimbursement for Baptist Health System.

Minimum Education, Experience, Training and Licensures Required

• Bachelor's degree

• Five years healthcare experience with two years in arevenue cycle related area such as registration, patientfinancial services, or managed care.

• In lieu of bachelor's degree, eight years of healthcare experience required including five years in one of therevenue cycle related areas listed above

• Requires knowledge of medical terminology; payor reimbursement guidelines (authorization / notification, medical necessity,and timely filing guidelines); payor denial appeal / payment variance resolution processes; and managed care contracts.

• Individuals working with payor audits must have a keen understanding of all audit response requirements and timelines.

Work Experience

Education