Payment Auditor

Job Description
Essential Job Functions

Audit and identify patient accounts paid incorrectly based on specific, active contracts with insurance payors.

Consistently review, prioritize, and clear designated payment variance work queues within the Epic electronic health record system.

Work from regular, high-volume financial reporting to actively target and isolate system-wide or account-level underpayments.

Log, track, and thoroughly document all underpayment discrepancies and audit findings within Epic.

Partner with payor contracting teams and external payors to recover identified underpayments. Track monitor and regularly communicate total collected revenue metrics to management.

Act as an internal resource to answer complex questions relating to reimbursement issues, payment terms, and contract structures for diverse patient populations.

Extract, manipulate, and analyze large, complex datasets to identify systemic contract non-compliance or systemic payor underpayments.

The duties listed above are representative of the role, and an individual may be responsible for performing all, or a specific subset, of these functions. Additionally, an individual may be required to perform other related tasks and responsibilities as applicable or assigned to meet operational and client needs.

Key Success Indicators/Attributes

Must be adept at multi-tasking and prioritizing a variety of tasks, often changing assignments on short notice in a fast-paced environment.

Strong analytical, critical thinking, and problem-solving skills to successfully manage individual KRAs and meet production metrics.

Excellent verbal, listening, and written communication skills to build trust, maintain credibility, and remain composed during stressful situations.

Perform data entry with accuracy while safeguarding corporate and client assets, proactively reporting any security compromises.

Skill in operating a computer and learning multiple software or hardware systems concurrently within an average workday.

Supervisory Responsibility

No

Work Environment

This job operates in a remote home office environment. This role routinely uses standard office equipment such as computers and phones.

Position Type/Expected Hours of Work

This is a full-time position. Days and hours of work are generally Monday through Friday, 8:00 a.m. to 5 p.m. This position occasionally requires long hours and weekend work.

Travel

Minimal travel required; up to 5%

Required Education and Experience

High school diploma, or equivalent.

Minimum 3 years of healthcare experience or a comparable combination of education and experience.

Ability to manipulate and analyze large amounts of data.

Strong foundational knowledge of medical billing practices and medical terminology.

Preferred Education and Experience

Direct experience handling payment variances or contract modeling within Epic.

Equivalent experience in managed care, health care finance, or healthcare information technology.

Additional Eligibility Qualifications

N/A

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice. Employee may perform other duties as assigned.

Qualifications
2 years of Epic
Require 3 years health care experience, or comparable education and experience.
Knowledge of medical billing and terminology required.
Proficiency in using Microsoft Office products, including Word, Excel and PowerPoint.
Proficiency in use of report writing software.
Able to manipulate and analyze large amounts of data.