Lead Reimbursement Auditor

Summary

Job Description:

Baptist Health is looking for a Lead Reimbursement Auditor to join their team. This is a remote position that requires residency in KY or IN.

Provides leadership and mentoring to reimbursement auditing operations along with implementation ofstandardized workflows and continued adherence to those audit practices. This position collaborates withManaged Care in the interpretation of Negotiated Payor Contract Terms and Payment Appendices, Provider Manuals, and Provider Policies / Bulletins to assure that flagged patient encounters with paymentvariances which include non-payment to contract terms or denial of services provided can appropriately bedisputed or appealed. Understands modeled expected reimbursement methodology as it applies to the services rendered to the Baptist Health patient.

Minimum Education, Experience, Training and Licensures Required

• Bachelor's degree; five years healthcare experience including two years ina revenue cycle related area such as registration, patient financial services, or managed care.

• In lieu of bachelor's degree, eight years of healthcare experience required including five years in one of therevenue cycle related areas as listed above.

• Requires knowledge of medical terminology; payor reimbursement guidelines (authorization / notification, medical necessity,and timely filing guidelines); payor denial appeal / payment variance resolution processes; and managed care contracts.Individuals working with payor audits must have a keen understanding of all audit response requirements and timelines.

Work Experience

Education