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Underpayment Auditor - Work from Home

Ensemble Health Partners Mason, OH Full-Time
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Underpayment Auditor

The Underpayment Auditor performs payment variance deep dive and review activities related to the incorrect processing of claims across Ensemble Health Partners. This position has the option of working remotely or on-site.

Job duties include, but are not limited to:

  • Understanding insurance contract terms, reviewing underpayments to determine if additional payment amounts can be requested
  • Identifying trends in payment discrepancies amongst payers
  • Auditing closed balance and write-off claims to ensure accuracy of payment to contract
  • Reviewing contract terms for revenue capture and maximization per billing and coding guidelines
  • Working with contract management to identify opportunities when negotiating contracts with payers.
  • Underpayment Auditors review large amounts of remittance data and analyze utilizing databases and modeling tools to identify areas of payment variance to contract or revenue optimization opportunities and take steps (appeals, corrected claims, etc) to resolve and capture the contractual underpayments.
  • Items identified are referred to the Underpayment Specialists for follow-up after identification and initial step to resolution.

Required Minimum Education: 2 Yr. Associates Degree, specialty/major: Business or relevant discipline

Minimum Years and Type of Experience: 1-2 years experience in healthcare industry.

Other Knowledge, Skills and Abilities Preferred: Experience in physician and hospital operations, compliance and provider relations.  Managed Care contracting experience preferred.

Certifications: CRCR within 6 months of hire.

Skills required

Medicare
Credentialing
Medicaid
Medical Management
Managed Care
Medical Necessity
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From a provider's standpoint, it's an age-old challenge: working with vendors and consultants who have good intentions, but are focused on a singular task or function within the revenue cycle and don't always have the experience or alignment with the provider to ensure that the upstream root cause is identified and corrected along with understanding the impact on the entire revenue cycle. In many cases, vendors are incentivized to correct issues in retrospect, not to help identify and hardwire a solution that prevents further downstream issues.

After years of working on the hospital and physician operations side and seeing great opportunity within revenue cycle to align the efforts of vendors and consultants with the long terms success of the organization, we set out to create a better way. We built a team of experienced hospital and physician revenue cycle leaders who not only understand in detail each segment of the revenue cycle but who have also personally been on the frontlines in helping solve many of the challenges in revenue cycle. Our partners and consultants have the unique ability to build relationships and connections with our clients because their backgrounds are similar and their interests are aligned. We believe that our people are our greatest asset and therefore take great care in selecting our team members.

Experience and passion for what we do and our approach toward partnership is what sets us apart. Since we've been on the provider side, our ability to analyze, develop strategy and execute on that strategy from a real-world point of view drives sustainable, long-lasting results that we can all be proud of.

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