Nurse Hospital Bill Audit Coordinator - Remote
The Hospital Bill Audit (HBA) Coordinator is responsible for coordination of HBA audit processes with field auditors, providers, and clients as well as initial prescreening of Hospital Bill Audit cases loaded to Audit System.
Essential Functions:
a.) Audit Coordinator Duties
Coordinate with Auditors and Providers
Track submission of audit results in a timely manner and processing of audit finalizations.
Review audit results for accuracy and assist HDI Auditor and Provider Internal Auditor with corrections to audit errors when found.
Obtain Audit Policies from providers and file updated copy in policy folder for future reference.
Monitor auditor's workloads to determine assistance requirements. If assistance is required reassign cases to other auditors for better efficiency and/or cost effectiveness.
Orient newly hired field auditors. Review HDI auditor manual, paperwork, Auditor Portal, HDI client processes and payroll procedures and requirements.
Monitor and assist with scheduling of audits at provider facility as needed.
Ensure that audit completions occur in a timely manner to include assisting in obtaining final sign off documentation for client/providers with no 30-Day Letter as needed.
Assist Auditors with provider access issues by intervening with provider representatives and client support as needed.
Assist HDI Auditors with acquiring proper (sometimes client specific) audit paperwork when it is not readily available and as needed.
Assist HDI Auditor and Provider Internal Auditor with missing required documents such as LOI's, patient authorizations, and audit finalizations as needed.
Monitor auditor's progress reports to make sure they are keeping them up to date. Assist with updates as needed.
Work with auditors, facilities and repricers to resolve bill total differences and confirm payment methodologies as needed.
Coordinate with Finance:
Perform Audit Fee approvals pre-audit.
Request audit fees manually for hospitals which require checks to be sent directly to the hospital pre-audit.
Request Medical Record or IB copy fees as necessary
Perform Expense Report approvals
Assist with clinical appeals as needed.
Cancel Audits when necessary due to audit timeout periods or through the direction of client communications or from the Department Director.
Reviews and monitors field auditor staffing adequacies and makes recommendations to Audit Coordinator Supervisor when current staffing is insufficient.
Attend Client Operations Meetings when requested by HBA Department Director
Monitor and Verify Client Disallowed Items Lists.
Assist with the maintenance of detailed tracking notes in HBA Audit System
Assist with the maintenance of Provider Tracking Tables
Assist with the maintenance of Client Tracking Tables
Coordinate with HDI Account Management Team Members as needed and requested.
Additional Duties as assigned
b.) Prescreen Duties:
Prescreen claims as assigned within a timely manner
Monitor audit results, hospital stats, and client stats and make recommendations to HBA Department Supervisor with regard to placing identified providers into a HOLD, HOLD-F, or EXCLUSION status.
Match providers in HBA Audit System for claims that are loaded with provider information that can't be matched to a provider on the provider table.
Other Functions:
Performs other functions as assigned
Knowledge, Skills and Abilities:
Working knowledge in, and successful application of, basic level healthcare data analysis and clinical review.
Ability to work proficiently with Microsoft Word and Excel
Ability to multi-task and prioritize work for self.
Ability to provide direction and exhibit self-motivated initiative to accomplish tasks.
Ability to perform well in team environment, with staff at all levels, to achieve business goals.
Ability to meet deadlines and appropriately prioritize and manage multiple initiatives.
Working knowledge of HIPAA privacy and security rules.
Comprehensive understanding of hospital coding and billing techniques and revenue centers
Computer skills in a Windows and Citrix based environment
Work Conditions and Physical Demands:
Primarily sedentary work in a general office environment
Ability to communicate and exchange information
Ability to comprehend and interpret documents and data
Requires occasional standing, walking, lifting, and moving objects (up to 10 lbs.)
Requires manual dexterity to use computer, telephone and peripherals
May be required to work extended hours for special business needs
May be required to travel at least 10% of time based on business needs
Certifications: (Required/Desired)
Current RN License or equivalent work experience preferred
Acute care experience preferred
Sound clinical judgment
Minimum Education:
Accredited RN Education Program
Minimum Related Work
Experience:
>3 years of clinical experience
Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.
. Apply now!Estimated Salary: $20 to $28 per hour based on qualifications.
Essential Functions:
a.) Audit Coordinator Duties
Coordinate with Auditors and Providers
Track submission of audit results in a timely manner and processing of audit finalizations.
Review audit results for accuracy and assist HDI Auditor and Provider Internal Auditor with corrections to audit errors when found.
Obtain Audit Policies from providers and file updated copy in policy folder for future reference.
Monitor auditor's workloads to determine assistance requirements. If assistance is required reassign cases to other auditors for better efficiency and/or cost effectiveness.
Orient newly hired field auditors. Review HDI auditor manual, paperwork, Auditor Portal, HDI client processes and payroll procedures and requirements.
Monitor and assist with scheduling of audits at provider facility as needed.
Ensure that audit completions occur in a timely manner to include assisting in obtaining final sign off documentation for client/providers with no 30-Day Letter as needed.
Assist Auditors with provider access issues by intervening with provider representatives and client support as needed.
Assist HDI Auditors with acquiring proper (sometimes client specific) audit paperwork when it is not readily available and as needed.
Assist HDI Auditor and Provider Internal Auditor with missing required documents such as LOI's, patient authorizations, and audit finalizations as needed.
Monitor auditor's progress reports to make sure they are keeping them up to date. Assist with updates as needed.
Work with auditors, facilities and repricers to resolve bill total differences and confirm payment methodologies as needed.
Coordinate with Finance:
Perform Audit Fee approvals pre-audit.
Request audit fees manually for hospitals which require checks to be sent directly to the hospital pre-audit.
Request Medical Record or IB copy fees as necessary
Perform Expense Report approvals
Assist with clinical appeals as needed.
Cancel Audits when necessary due to audit timeout periods or through the direction of client communications or from the Department Director.
Reviews and monitors field auditor staffing adequacies and makes recommendations to Audit Coordinator Supervisor when current staffing is insufficient.
Attend Client Operations Meetings when requested by HBA Department Director
Monitor and Verify Client Disallowed Items Lists.
Assist with the maintenance of detailed tracking notes in HBA Audit System
Assist with the maintenance of Provider Tracking Tables
Assist with the maintenance of Client Tracking Tables
Coordinate with HDI Account Management Team Members as needed and requested.
Additional Duties as assigned
b.) Prescreen Duties:
Prescreen claims as assigned within a timely manner
Monitor audit results, hospital stats, and client stats and make recommendations to HBA Department Supervisor with regard to placing identified providers into a HOLD, HOLD-F, or EXCLUSION status.
Match providers in HBA Audit System for claims that are loaded with provider information that can't be matched to a provider on the provider table.
Other Functions:
Performs other functions as assigned
Knowledge, Skills and Abilities:
Working knowledge in, and successful application of, basic level healthcare data analysis and clinical review.
Ability to work proficiently with Microsoft Word and Excel
Ability to multi-task and prioritize work for self.
Ability to provide direction and exhibit self-motivated initiative to accomplish tasks.
Ability to perform well in team environment, with staff at all levels, to achieve business goals.
Ability to meet deadlines and appropriately prioritize and manage multiple initiatives.
Working knowledge of HIPAA privacy and security rules.
Comprehensive understanding of hospital coding and billing techniques and revenue centers
Computer skills in a Windows and Citrix based environment
Work Conditions and Physical Demands:
Primarily sedentary work in a general office environment
Ability to communicate and exchange information
Ability to comprehend and interpret documents and data
Requires occasional standing, walking, lifting, and moving objects (up to 10 lbs.)
Requires manual dexterity to use computer, telephone and peripherals
May be required to work extended hours for special business needs
May be required to travel at least 10% of time based on business needs
Certifications: (Required/Desired)
Current RN License or equivalent work experience preferred
Acute care experience preferred
Sound clinical judgment
Minimum Education:
Accredited RN Education Program
Minimum Related Work
Experience:
>3 years of clinical experience
Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.
. Apply now!Estimated Salary: $20 to $28 per hour based on qualifications.
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