Reimbursement Auditor
Wellstar Health Systems

Job Info

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Facility: VIRTUAL-GA
Job Summary: Under direction of the Director of Revenue Management, this position is responsible for performing defensive, concurrent, retrospective and patient requested bill audits to determine accuracy of billed charges. Provide timely answers to patient questions to enhance customer service. Interact with all hospital departments with lost charge problems and provide education on issues to prevent reoccurence. Complete and review productivity and departmental reports. Core Responsibilities and Essential Functions: Perform concurrent medical record audits. * Review and interpret clinical documentation to verify charge on claim * Review account financials for accuracy. * Adjust claims if audit finding identifies errors in billing or compliance issues. * Review and adjust Medicare Observation Status carve out minutes Perform retrospective audits * Work with payer to negotiate proper adjustment to claim. * Review account financials for accuracy. * Adjust claims if audit finding identifies discrepancies. * Review Defense Audits * Review Payor request Audits as need * Review Pre-Bill Audits * Handle customer service referrals * Perform other duties as assigned * Perform Focus Audits to identify trends in charging errors Educate clinical and support services * Report trends and charge errors to RMD Director and Executive Director * Work with projects team to formulate education plan and presenting education sessions for appropriate departments Performs other duties as assigned Complies with all WellStar Health System policies, standards of work, and code of conduct. Required Minimum Education: Graduate of accredited Licensed Practical Required or Registered Nursing program with license to practice in Georgia Required Required Minimum License(s) and Certification(s): All certifications are required upon hire unless otherwise stated.

• Lic Practical Nurse or Reg Nurse (Single State) or RN - Multi-state Compact

Additional License(s) and Certification(s):Required Minimum Experience: Minimum 2 years Acute Care Nursing Experience along with Charge Capture Audit, Medical Coding, Reimbursement Case Management or Revenue Cycle Experience Required Required Minimum Skills: Computer/data entry experience. Ability to communicate with various members of the healthcare team. Intermediate EXCEL skills and basic skills of all other Microsoft Office products. Epic experience preferred. Must be organized and multi-task oriented. Self-directed, able to work independently. Ability to communicate clearly and professionally with staff at all levels in the organization and external customers. General knowledge of medical claims submission process for non-government insurance carriers. Ability to interpret managed care contracts and understanding of general terminology. Able to navigate CMS Website and Manuals. Able to interpret CPT/HCPCS and ICD-10 codes. Maintains professional licensure

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