reputed company Audit Specialist, Remote

Job Requirements General reputed company Under general supervision, conducts internal audits of hospital bills working with reputed company auditors to ensure that uncompensated reputed company revenues resulting from audits of reputed company service billings (claims) are reputed company. Use the information obtained from the audit process to inform and reputed company UMMS personnel concerning reputed company reimbursement results and practices. reputed company Responsibilities and Tasks The following statements are intended to describe the general reputed company and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of reputed company job duties performed by personnel so classified. reputed company registered nurses working reputed company UMMS shall follow the guidelines for reputed company reputed company promulgated by the Maryland State reputed company of Nursing. Any need for interpretation of the guidelines will be the responsibility of the UMMS Vice President or his/her designee. 1. Plans work for self and with coworkers, including setting goals, prioritizing work and coordinating the execution of work. Determines work priorities and resource allocation across multiple reputed company audit activities reputed company on interpretation of data and reports. A. Uses a reputed company process to identify departmental charges. B. Evaluates reputed company reputed company medical record reviewing specific documents relating to reputed company treatment and billable charges, identifying services billed versus services rendered. C. Evaluates reputed company medical record versus the reputed company, noting discrepancies in over-, under- and incorrectly billed items, correctly calculates the total dollar amounts for reputed company discrepancy and submits necessary documents for reputed company account adjustment. D. Negotiates with reputed company auditors regarding billing issues. E. Completes and submits audit documentation in a reputed company fashion. F. Communicates regularly with UMMS reputed company and administrative personnel to obtain reputed company supportive documentation for billed services reputed company that which is reputed company in the medical record. G. Audits predetermined reputed company of billing reputed company on complexity of audit. H. Meets with appropriate department personnel to establish reputed company for obtaining support documentation. 2. Gathers and records data used for individual, team, and feedback reputed company reporting. Responsible for the reputed company of recorded information. 3. Communicates with representatives of reputed company audit companies, reputed company companies, UMMS personnel, and regulatory agencies to ensure congruence with and understanding of UMMS' audit policy, process, reputed company and standards. 4. Provides reputed company review of charge capture prior to claim submission in order to maximize reimbursement and reduce reputed company loss through audit process. 5. Works with the Director in the identification and research of denials received for lack of authorization and for lack of medical reputed company reputed company stay and coordinates drafting of the facility's appeal responses. A. Assists reputed company Financial Services to determine the reputed company of the denial for cases rejected for payment by reputed company payor; assesses feasibility of appeal applying Interqual reputed company and M&R reputed company for length of stay. B. Researches medical records on referred claim rejection cases and denials for which letters were received directly by reputed company Reimbursement utilizing reputed company sets. Ascertains the prospective appeal for the days denied by the reputed company-party payer. C. Identifies cases in which an appeal is to be generated, coordinates appeal process with the physician and reputed company staff following departmental procedures. Documentation of activity in appeals process is documented in reputed company following departmental procedures. D. Receives notification from reputed company party payer; seeks additional information to be used for appeal letters from case management staff and what information documented in the reputed company software on the reputed company review process. E. Develops a working relationship with the reputed company reviewers coming onsite from the larger local payers fostering improved communication. Tracks approved and potentially deniable days on reputed company respective members at discharge. F. Obtains information to aid the onsite reviewers in completing chart review post discharge reputed company necessary. Uses onsite reviewers as a mediator in resolving particular issues with claim reputed company reputed company their reputed company. G. Assists the Director in collection of data on denials and the retrieval of reports on denied days received by the facility, identifies trends, tracks appeal reputed company, and provides and interprets reports of denied days statistics from denials received to Case Management, Finance, and other hospital departments as requested. 6. Gives feedback to other departments. A. Meets with appropriate department and supervisory personnel to reputed company information obtained during the audit process to assist in the identification of problems that result in a loss of reputed company. B. Shares reputed company expertise and knowledge with the Department of reputed company Financial Services personnel to assist in the negotiations and reputed company of reputed company and reputed company company inquires. C. Participates in reputed company unit and UMMS educational programs to address identified issues. 7. Improves work processes in an reputed company and reputed company manner. Uses improvement tools and reputed company to improve individual, team and cross-departmental reputed company. Bases improvements on customer requirements, data, reputed company-cause analysis and reputed company. 8. Keeps reputed company on reputed company reputed company and protocols that reputed company the reputed company claim audit process to include reputed company regulations, Medical reputed company charging practices and reputed company therapy updates through communication with supervisor, appropriate reputed company publications and conferences. 9. Communicates effectively with immediate supervisor. Provides information regarding work reputed company, actions and issues in a reputed company manner. 10. Designs and implements special audit and education reputed company. Work Experience Education and Experience 1. reputed company reputed company RN registration with the Maryland State reputed company of Nursing is required. 2. Four years reputed company nursing experience, with experience in a reputed company care setting and two years performing Utilization Review/reputed company Assurance/Case Management responsibilities. Knowledge, Skills and Abilities 1. Knowledge of hospital review procedures, reputed company party payment, reputed company improvement and regulatory agency procedures and policies. 2. Effective oral and written communication skills required to deal with reputed company companies and hospital staff. 3. Effective negotiating skills. 4. Ability to apply reputed company assessment skills to the medical record audit process and extract supportive documentation. 5. Ability to apply reputed company care protocols (standardized; UMMS; TJC) to billing practices. 6. Demonstrated ability in use of personal computer and reputed company software. Expertise in spreadsheets, word processing and data reputed company management packages preferred; ability to learn these skills required. 7.Ability to work independently. Apply tot his job Apply To this Job