Insurance Reimbursement Auditor, 250 E. Liberty, 8:00a-4:30p

Insurance Reimbursement Auditor

The Insurance Reimbursement Auditor is primarily responsible for the review on paid insurance claims (including $0.00 pay) and payor recoupments to successfully determine if reimbursement is accurate according to current contracted rates. This employee follows up with government, managed care, commercial, and third party payers on outstanding monies due for services rendered to a patient. This employee will provide "root cause" analysis and trend identification of revenue opportunities to ensure appropriate reimbursement for UofL Health facilities.

• Perform thorough research of paid claims (including $0.00 pay) for appropriate follow up with payer.

• Provide detailed analysis of findings and payer trends.

• Review claim remittances to determine reimbursement rates and methodologies used by the payer when processing the claim.

• Identify opportunities with underpayment or contract language that is determinant to reimbursement and report findings to leadership.

• Perform extensive review of high dollar accounts that are subject to alternative reimbursement terms to validate payments are in accordance with contracted rates.

• Responsible for reviewing and understanding explanation of benefits/remittance advice from third-party payers.

• Process and review incoming correspondence from payers related to underpayment or high dollar/outlier payment discrepancies.

• Audit, research accounts, payment posting, and contractuals to confirm the accuracy of the balance, financial class, and follow up schedule on the account.

• Phone contact with patient, physician office, attorney, etc. for additional information to provide payer in order to process claim in accordance with contracted rates.

• Communicate payment discrepancies to payer specific provider representatives via email, phone, or scheduled in-person meetings.

• Work with reimbursement and contract modeling team members to verify contracted rates are properly calculated with contract modeling system.

• Maintain regular contact with Managed Care & Contracting management team to ensure all new contract agreements/updated rates are received timely and effective dates for new rates are communicated to the appropriate Revenue Cycle teams.

• Prepare and submit letters, emails, faxes, online inquiries, appeals, and adjustments.

• Document all follow up efforts in a clear and concise manner into the AR system.

• Work assigned accounts as directed while reaching daily productivity goals.

• Complete tasks by deadline provided by leadership.

• Participate in system testing and training.

• Attend seminars as requested.

• Other duties as assigned.

Minimum Education and Experience

• High School Diploma or GED

• 2-3 years of billing, insurance follow-up or insurance payor experience

• Experience performing account resolution with third-party payors is preferred

• Experience in working with ICD-10, revenue codes, CPT-4 and HCPCS

• Moderate computer proficiency including working knowledge of MS Excel, Word and Outlook

Knowledge, Skills, and Abilities

• Ability to read and interpret documents, i.e. contracts, claims, instructions, policies and procedures in written (in English) form.

• Ability to calculate rates using mathematical skills.

• Ability to define problems, collect data, and establish facts to execute sound financial decisions in regard to patient account(s).

• Must have detailed knowledge of the uniform bill guidelines.

• Ability to be persistent in the follow up of underpaid or partially paid claims in a timely manner.

• Ability to review, comprehend, and discuss HCFA billing with Insurance or Government agencies.

• Knowledge of general insurance requirements.

• Experience working directly with EOBs, contractual adjustments, and payer contracts.

• General computer knowledge and working with electronic filing systems.

• Ability to communicate verbally and in writing with professionalism.

• Organizational and documentation skills to ensure timely follow-up and accurate record keeping.

• Ability to meet productivity expectations.

• Strong team player.

• Strong self-motivation to achieve goals.