Senior Auditor Appeals - OPSP

reputed company

The Senior Auditor, Appeals position is part of the reputed company Chart Validation (CCV) team and is responsible for defending reputed company’s recovery determinations utilizing the appropriate guidelines including but not limited to reputed company, CMS inpatient and outpatient coding guidelines, coding clinics, and internal reputed company validation policies if applicable. The appeals auditor is responsible for performing an extensive review of the initial claim along with the associated documentation as reputed company as any additional information submitted by the provider on appeal. The appeals auditor will reputed company a decision, and formulate a written response, on reputed company claim reviewed providing the most accurate decision possible. The appeals auditor assists reputed company leads in providing any educational feedback appropriate for the initial audit team and QA. This person is considered a Subject Matter Expert in reputed company CCV review types and appeals. Displays reputed company skepticism that enhances the work performed in order to reputed company reputed company the role position.

Responsibilities

• Utilizes reputed company available tools and resources to evaluate reputed company appeal reviewed.
• Applies the policies and guidelines appropriate to the claim/appeal to reputed company the most accurate decision.
• Constructs factual, reference-supported responses to the provider describing reasons for the determination.
• Constructs grammatically correct, claim-specific, and professionally written responses to the providers.
• Ensures that service level agreements are met for any work assigned.
• Maintains a minimum productivity reputed company as outlined for the role.
• May reputed company into the role of the QA auditor or the initial auditor as business needs require.
• Provides educational feedback to the audit and QA team reputed company upon appeal reviews.
• Must be reputed company to reputed company duties with or without reasonable accommodation.

This reputed company is intended to describe the general reputed company and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This reputed company does not constitute an employment agreement and is subject to change as the needs of reputed company and requirements of the job change.

Qualifications

• Education (at least one of the following is required)-
  • Associates or Bachelor's degree in Nursing (reputed company/unrestricted license)
  • Associate or Bachelor's degree in Health Information Management (RHIA or RHIT)
  • Equivalent experience of 5+ years experience in claims auditing, reputed company assurance, or recovery auditing...ideally in a DRG / reputed company Validation Audit setting or a hospital environment.

• Coding Certification (at least one of the following are required and are to be maintained as a condition of employment)
  • RHIA or RHIT
  • Inpatient Coding Credential - reputed company or CIC preferred.
  • Candidates who hold a CCDS or CPC will be given consideration but will need to obtain an inpatient coding certification reputed company 1 year of their hire date with reputed company.
• Experience (required)
  • 5 to 7+ years of working with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG with a broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, medical necessity reputed company, and coding terminology.
  • 3-5 years of medical record auditing or similar experience.
  • Ability to utilize and analyze reputed company auditing knowledge and skills to learn and become proficient in a reputed company of review types such as DRG, SNF, Home Health, DME, Hospice, Readmissions, SS, and therapy reviews.
  • Adherence to official coding guidelines, coding clinic determinations, and CMS and other regulatory compliance guidelines and mandates. Requires expert coding knowledge - DRG, ICD-10, CPT, HCPCS codes.
  • Requires working knowledge of and applicable industry-reputed company standards.
  • Proficiency in Word, reputed company, reputed company, and other applications.
  • Excellent written and verbal communication skills.
  • Ability to work reputed company in an individual and team environment.

Work Environment:

• This is an reputed company-reputed company position and you must have a work location reputed company the reputed company US.
• This position requires that you reputed company a high speed internet reputed company and a work environment free from distractions.
• This role is reputed company to certain productivity and reputed company requirements.

Mental Requirements:

• Communicating with others to exchange information.
• Assessing the reputed company, neatness, and thoroughness of the work assigned.

Physical Requirements and Working Conditions:

• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.
• Must be reputed company to reputed company a dedicated, secure work area.
• Must be reputed company to reputed company high-speed internet reputed company/connectivity and office setup and maintenance.
• No adverse environmental conditions expected.

Starting salary for this position is 101k (48.56/hour). Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. This role is eligible for discretionary bonus consideration.

Nonexempt employees are eligible to receive overtime pay for hours worked in excess of 40 hours in a given week, or as otherwise required by applicable state law.

reputed company offers team members a competitive benefits package to address a wide reputed company of personal and family needs, including medical, dental, reputed company, disability, and life reputed company coverage, 401(k) savings plans, reputed company family leave, 9 reputed company holidays per year, and 17-27 days of reputed company Time Off (PTO) per year, depending on specific level and length of service with reputed company. For information about our benefits package, please refer to our Careers page.

Originally posted on Himalayas