Summary

The Payor Audits and Appeals Coordinator will be responsible for monitoring timely and accurate. Tracking and follow up of requests for information for all entities of The Guthrie Clinic. The Coordinator will also be responsible for timely coordination of appeals and associated deadlines and reconciliation of payments and recoupments. The Coordinator will provide trending reports and reports reflecting recovery activity relative to requests, responses, appeals, denials and recoupments. The Coordinator will establish and maintain responsive and collaborative relationships with corporate compliance, billing, coding, case management, finance, administration and medical staff. The Coordinator will be responsible for ensuing system- wide compliance with Federal, State, or regulatory agency audit and appeal programs

Experience

A minimum of five years of direct experience involving the assignment, review, analysis and/or audit of professional and hospital diagnosis and procedure codes.  Experience in a healthcare environment required with knowledge of Medicare, Medicaid, and third party payers, rules and regulations.  Demonstrated written and verbal communication.  Skill in establishing and maintaining effective working relationships with both corporate and clinical departments.  Basic Microsoft Office software skills Working knowledge of Coding {ICD-10-CM, CPT4, and HCPCS}--preferred.. 

Education

Bachelor's Degree in a quantitative field, such as accounting, finance; health care experience preferred.

Essential Functions

Conduct oversight of all third party recovery functions. Track status of all third party recovery activity using automated tracking system from receipt to closure. Open communication between Coordinator and applicable parties, including; Administration HIM/Coding/Release of Information Patient Business Services Finance Case Management Regulatory Agencies and Recovery Agencies ( ie CMS, Medicaid) Coordinate all activities associated with third party recovery requests and appeals. Manage and track third party recovery timeliness for requests and third-party responses. Communicate with all affected external entities involved in the third party recovery process. Analyze audit and third-party recovery findings. Coordinate the third-party recovery committee with reports to Internal Audit and Compliance team and administrative leadership. Provides reconciliation reports to CFO for reserve calculations as requested.

Other Duties

1. Travel is frequently required within Guthrie region and sites

2. It is understood that this description is not intended to be all-inclusive and that other duties may be

assigned as necessary in the performance of this position.

 

Pay range for the position is $50,710/yr - $79,123/yr