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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
20193517
Job Description
  1. 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.
  2. Ability to manipulate data in spreadsheets in order to report trends and statuses to Director.
  3. Analyze and interpret complex, managed care contracts, provider requirements and payment methodologies for hospital and physician reimbursement.
  4. 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.
  5. Negotiate and insist accountability with third party payers on accounts through accurate and timely follow-up.
  6. Document precisely and timely in billing application and contract management software.
  7. Utilize available resources (online websites, contract management software, payer contacts) to aid in the expedient recovery of underpaid funds.
  8. Maintain a high level of professionalism while aggressively overturning underpaid claims by third party payers.
  9. Must be flexible, able to work independently and able to achieve deadlines and deliverables with minimal supervision.
  10. Perform other duties as assigned by Director.

Qualifications/Training:

  1. Working knowledge of managed care terminology, managed care reimbursement methodologies
  2. Working knowledge of Patient Financial Services. Experience working with governmental payers (Tricare, Medicare, Medicaid), Medicare Advantage payers, and Medicaid MCO payers preferred.
  3. Procedural knowledge of account receivable management.
  4. Understanding of basic revenue cycle
  5. Excellent interpersonal, written and organizations skills
  6. Attention to detail and accuracy skills required.
  7. Experience with problem solving techniques.

Licenses/Certifications/Registrations/Education:

  • 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
Full-Time/Regular
Position Type Details
Full-Time
Physical Address
McLeod Medical Plaza, 800 East Cheves Street

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