Job Summary - Assist in managing and analyzing hospital bill audits by third party payers. Position will serve as liaison between payors, hospitals, and the Shared Service Center (SSC) regarding status of pending, ongoing and finalized audits. Position will evaluate the requests received by the payors to assess if the request is within the terms established by contracts and in accordance with the Hospital Bill Audit by Third Party Payers Policy. Position will notify appropriate responsible parties of reviews and maintain documentation of audit requests, current status, and outcomes of audits in a centralized location. Position will track and trend types of audits received and report findings to Manager.
Supervisor - Revenue Integrity Manager
Supervises - N/A
Key Interactions - Interacts and coordinates handoffs of audits between responsible SSC departments such as Revenue Integrity for insurance charge audit reviews, HSC for coding or DRG related reviews and Ethics and Compliance and HCA - Regulatory Compliance Support (Regs) for government audits. Position will communicate with payor representatives related to audit request and coordination of audits to be performed.
Duties (included but not limited to):
. Analyze and approve audit requests received from payors
. Interact with payor to resolve questions or concerns related to coordination of audit request
. Maintain tracking of audits and coordinate obtaining the medical record for auditor to perform on-site audits
. Communicate approved and denied insurance defense audits
. Maintain statistical data as required
. Practice and adhere to the "Code of Conduct" philosophy and "Mission and Value Statement"
. Other duties as assigned
Knowledge, Skills & Abilities
. Excellent communication skills both verbal and written
. Good interpersonal skills
. Able to establish good customer relationships with trust and respect
. Excellent organizational skills
. Ability to work with limited supervision
. Excellent statistical skills
. Computer skills: navigation and edit resolution through various Web based systems, ability to use email, Excel, Word.
. Knowledge of payer contract requirements preferred but not required
. Associate degree preferred; Equivalent work experience may substitute.
. Three years of hospital business office or related financial experience preferred.
. Project management and payor contract experience preferred.
A little about us:
HCA is the nation’s leading private provider of healthcare services. Comprised of locally managed facilities which include 230,000 employees at over 160 hospitals, over 120 surgery centers and 100 urgent care facilities in 20 states and the United Kingdom