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Managed Care Contract Auditor - Government (Tricare, Medicare, Medicaid)Florence, South Carolina
Managed Care Contract Auditor - Government (Tricare, Medicare, Medicaid)
- Tracking Code
- Job Description
- Maintains a professional image and exhibits excellent customer relations to patients, visitors, physicians, and co-workers in accordance with our Service Excellence Standards and Core Values.
- Ability to manipulate data in spreadsheets in order to report trends and statuses to Director.
- Analyze and interpret complex, managed care contracts, provider requirements and payment methodologies for hospital and physician reimbursement.
- Investigate, determine, pursue, and overturn with accuracy and timeliness underpaid accounts by insurance payers. Thoroughness and reliability are essential because of the nature of the work and for credibility with the payers.
- Negotiate and insist accountability with third party payers on accounts through accurate and timely follow-up.
- Document precisely and timely in billing application and contract management software.
- Utilize available resources (online websites, contract management software, payer contacts) to aid in the expedient recovery of underpaid funds.
- Maintain a high level of professionalism while aggressively overturning underpaid claims by third party payers.
- Must be flexible, able to work independently and able to achieve deadlines and deliverables with minimal supervision.
- Perform other duties as assigned by Director.
- Working knowledge of managed care terminology, managed care reimbursement methodologies
- Working knowledge of Patient Financial Services. Experience working with governmental payers (Tricare, Medicare, Medicaid), Medicare Advantage payers, and Medicaid MCO payers preferred.
- Procedural knowledge of account receivable management.
- Understanding of basic revenue cycle
- Excellent interpersonal, written and organizations skills
- Attention to detail and accuracy skills required.
- Experience with problem solving techniques.
- Minimum of a High School Diploma/GED from an accredited school
- 6 years of experience in healthcare finance
- Job Location
- Florence, South Carolina, United States
- Position Type
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