To be part of the Revenue Recovery Team to identify saving potential to the company prospectively as well as retrospectively in areas of claims savings, process improvements, reconciliations, billings, etc.
Identify saving possibilities on high dollar hospital claims auditing, to include all or some components from authorization, itemized bill, chart and MARS reports.
Assist with High dollar check review process and IBNR pre-screening process for G/L booking and potential savings on paid claims.
Data Mining claim audits for recovery opportunities based on overall accuracy of paid claims beginning from contract language, configuration and claims payment practices.
Help to develop and maintain auditing processes to include automated functionality wherever possible (programming experience not required, familiarity of automation potential a plus). Work with team of auditors to train and monitor ongoing audit processes.
Hospital Certified Coder with hospital auditing experience:
CCS certified / by AHIMA (American Health Improvement Mgmt Assoc)
CPC H (H = Hospital Coding) certified / by AAPC (American Assoc. of Professional coders).
Windows Excel experience and recent use is very desired. Organized, analytical thinking capabilities is a must.
NAMM North America Medical Management - 22 months ago