LOOKING FOR A JOB WHERE YOU CAN MAKE A DIFFERENCE?
We are looking for Healthcare Claims Compliance Auditors in Revenue Cycle Management (RCM), who want to help us protect patients, emergency safety net providers, and the nation’s healthcare delivery system.
ABOUT THE POSITION:
Our healthcare advocacy firm is enlisting a few great seasoned Revenue Cycle/Healthcare professionals and/or JDs to work in its Claims Compliance Audit Division, to help transform the healthcare delivery system.
Duties include:
· Conduct unfair trend analysis with problem/project payors to initiate, monitor, and follow-up projects (e.g., mass enforcements, corrective action plans)
· Upload audit/project findings to the internal system
· Send Enforcements, NOIFCs, and Affidavits to payors
· Call NOIFC recipients to redress violations before complaint filing
· File regulatory complaints with merit to the appropriate agency
· Organize, request, and send regulatory agency requested documents from the client
· Sort and respond to payor correspondence (denials and requests, etc.)
· Hold payor compliance meetings to initiate corrective action plans
· Review CCO assigned cases for merit review or closure.
· Track and follow up on projects to ensure deadlines are met and no professional shortcoming has occurred—that cases are decided timely pursuant to the applicable state and federal law
· Prelitigation Support/Consulting
· Audit team unresolved complaints filed with a regulatory agency over 6 months to escalate to senior payor agency officials
· Shadow and consult clients remotely or onsite (in training)
· Prepare deliverables
· Perform other job-related duties as assigned by management.
The Healthcare Claims Compliance Auditor (RCM) must possess:
- A four-year degree (healthcare or law degree a plus) OR at least 4-7 years in a HC revenue cycle, compliance, or lead position.
- PC skills in a Windows environment are required. Knowledge and utilization of desktop applications to include Word and Excel is essential.
- Ability to manage a high volume of cases daily.
- Excellent verbal and written communication skills.
- Typing skills at least 50wpm.
- Ability to begin, follow through on projects, meet deadlines, and work independently with minimal supervision.
- People Skills – Ability to work well with others in a professional setting. Able to work, communicate effectively, and cooperate with vision, company policy, co-workers, supervisors, and other company departments.
- Initiative – Ability to seek out new assignments and assume extra duties without being asked. Proposes innovative ideas and works to find better ways to accomplish tasks and meeting departmental goals.
- Quality Production – Able to produce efficiently and accurately a significant volume of quality work in a specified period to meet department goals.
- Reliability – Consistent in attendance, punctuality, follow through, and task completion. Accepts responsibility for mistakes and is accountable for errors.
- Job Knowledge – Possess, develop, demonstrate, and maintain knowledge required on the job, inclusive of mastering administrative prompt payment laws.
- Adherence to Policy and Company Core Values – Honest and ethical; follows safety and conduct rules, other regulations, and adheres to all company or corporate compliance manuals.
DISCLAIMER:
These statements are intended to describe the general nature, level, and requirements of work being performed by the people assigned to this position. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. The listed duties may be changed at the discretion of the incumbent's supervisor.
WORK REMOTELY:
PRIVACY REQUIREMENTS:
Ensuring timely authorizations, prompt and fair payment of healthcare providers are critical to the stability of America’s health care delivery system.
This Healthcare Claims Compliance Auditor (RCM) position requires access to confidential protected health information (PHI). This employee is expected to protect the privacy of all PHI in accordance with ERN/TRAF’s privacy policies and procedures, as required by state and federal law (including but not limited to the HIPAA Security and Privacy Rule.)
Although this position requires access to PHI to do their work, the employee will have access to only the minimum amount of PHI necessary for the business function and understands that further use or disclosure of PHI is a violation of HIPAA's Safeguards and those requirements of the Privacy Rule.
APPLY NOW:
For immediate consideration, please e-mail your resume and salary requirements or fax to 714-995-6901.
Job Type: Full-time
Pay: $37,440.00 - $60,552.00 per year
Benefits:
- 401(k)
- Dental insurance
- Employee assistance program
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Work Location: In person
