Coordinator - Third Party Audits

Overview

Research Patient accounts related with audits and activity from Third Party Payers and internal audits in accordance with therequired timeframe. Identify and report root cause for all audit recoveries by Third Party Payers and recommends and participate in corrective action plan for Bronxcare Health System/MLK.

Responsibilities

Contributes to and participates in the Performance/Quality Improvement activities of the assigned department. Contribution and participation includes data collection, analysis, implementation of and compliance with risk management and claims activities, support of and participation in Continuous Quality Improvement (CQI) teams, consistent adherence to the specific rules and regulations of the Bronxcare Health System (a) Safety and Security Policies, (b) Risk Management: Incident and Occurrence Reporting, (c) Infection Control Policies and Procedures and (d) Patient and Customer Service Identifies and reports root causes for Audit recoveries by Third Party Payers and recommend /participate in corrective action for BCHS and MLK. Communicate with all Third Party Payers and internal parties to obtain required information to finish the assignment satisfactorily and within the required time frame.Responsible to ensure compliance regarding billing and timeliness on followup for all assigned accounts received. Utilizes all information systems toretrieve, verify and or appeal denied cases in payer web portal as appropriate Responsible for obtaining medical records for claims that are denied by the payer requesting clinical information. Obtains and submits medical records to the payer, as required. Reviews and obtains UM status and or action recorded

Qualifications

Three (3) to Five (5) years’ experience of collection in finance knowledge of Medicare and Medicaid reimbursement processing preferred Experience with the maintenance of the patient file information Experience in billing information systems Experience in a Health Care environment preferred Strong communication skills both verbal and writtenGood analytics skills Ability to multi-task and willingness to learn new skills Ability to deal effectively with multiple information sources