Revenue Cycle Reimbursement Auditor

Job Description

Job Description

Description:

Titan Health Management Solutions (Titan) has been in operation since 2002 as a firm specializing in zero balance auditing and recovery. Our unique business model and expertise has allowed us to rapidly expand into other markets and other lines of business. We welcome you to visit our website at

We are searching for individuals who are passionate about what they do and have a strong desire to succeed. If you have an entrepreneurial spirit, and desire to push yourself beyond the limit of what you ever thought possible, come join our team and enjoy the success. Become part of a leading and innovative company in Revenue Cycle Services and watch your efforts help change healthcare for the better!

Essential Job Duties/Responsibilities

As a Reimbursement Auditor, you will play a pivotal role in ensuring our clients' claims are processed accurately and identifying areas where additional revenue can be pursued. Your responsibilities will include:

• Audit Excellence: Conduct thorough audits of hospital insurance claims payments, including Medicare and Medicaid, ensuring compliance with coding rules and payment standards. Perform in-depth research to verify the accuracy of claim payments or the legitimacy of denials, including proactive communication with insurance plans when necessary.
• Contract Insight: Analyze contract language to identify potential areas for payment errors before they occur, contributing to proactive management of reimbursement processes.
• Error Identification : Detect and verify underpayments by insurance plans, ensuring accurate financial reconciliation for our hospital.
• Appeal Craftsmanship: Develop compelling appeal and grievance arguments, including precise calculations of short payments. Draft and submit appeal letters or reconsideration requests via various channels (phone, fax, email, or payor portal).
• Appeal Management: Review and audit paid appeal amounts to confirm accurate resolution. Draft and submit secondary appeals when necessary, ensuring comprehensive follow-up on underpaid accounts.
• Collaborative Collection: Assist in the collection of appeals by effectively communicating with insurance plans to expedite accurate payments when needed.
• Team Culture: Upholds organizational values to help foster a trusting and respectful work environment.

Minimum Qualifications

• In-Depth Knowledge : Expertise in Commercial, Medicare, and Medicaid claims, including a thorough understanding of billing, coding rules, and claim forms (UB04 and HCFA 1500) and reimbursement. Along with, detailed understanding of CPT/HCPCS and ICD10 coding.
• Analytical Skills : Proficiency in contract analysis and interpretation with at least 1 year of experience in contract analysis and hospital or physician claims auditing.
• Appeal Experience: Hands-on experience with payor reconsiderations and appeals, including drafting appeal letters and following up with payors.
• Technical Skills : Proficiency in Microsoft Office (Word and Excel) with at least 1 year of experience. Certification such as Certified Outpatient Coding (COC) or Certified Professional Coding (CPC) is preferred.
• Communication: Exceptional oral and written communication skills, with a focus on customer and client service.

Technical Skills:

• High school diploma or equivalent.
• Proficiency in Microsoft Office (Word and Excel) with at least 1 year of experience.
• 2 years prior experience in reimbursement auditing, contract and financial review.
• CPC-A, CPC preferred

Work Environment

• Work from home: your workspace should be large enough to work efficiently with reliable internet connectivity.

Performance Standards

• Attitude: Demonstrate a positive and professional demeanor toward supervisors, co-workers, and clients.
• Reliability: Show commitment and initiative in your role, with a strong focus on job performance and follow-through.
• Quality: Deliver high-quality work with attention to detail and accuracy.