[Hiring] Healthcare Documentation Auditor @Performant Corp
This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more.
Role Description
The focus of the Healthcare Documentation Auditor is the performance of timely and effective reviews to assess documentation and billing accuracy for post and prepayment claims on behalf of Government and Commercial Payers.
• Review medical records for services billed and validate required documents and information is contained within the records submitted for various service types as required by clients.
• Applying local coverage determination (LCD), national coverage determination (NCD), and commercial payer policy to services in review.
• Document and articulate review findings and reference the appropriate policies and rules in the audit platform and as rationale language.
• Working collaboratively with the audit team to identify vulnerabilities and/or cases subject to potential abuse.
• Keep abreast of changes in technology and regulatory issues that may affect our business and clients.
• Suggest ideas that may improve audit workflows.
• Participate in the development of Review Guidelines and meetings as necessary.
• Cross-train in other audit types/focus areas or management teams as applicable.
• Maintain required quality and productivity standards.
• Performs other duties as assigned.
Qualifications
• Familiarity with insurance programs, particularly the coverage and payment rules, and audit types to validate against orders, units, and signatures.
• Demonstrated knowledge of medical terminology.
• Ability to maintain high-quality work while meeting strict deadlines.
• Excellent written and verbal communication skills.
• Experience using the following applications is preferred: Word, Excel, and e-mail.
• Must be able to independently use standard office computer technology (e.g., email, telephone, copier, etc.) and have experience using a platform to review and document findings.
• Must be able to manage multiple assignments effectively, organize and prioritize workload, problem solve, work independently and with team members.
• Courteous, professional, and respectful attitude.
• Flexibility to handle any non-standard situations that may arise.
Requirements
• High School Diploma or GED is required. Some college is preferred.
• At least two years’ experience in adjudicating/examining claims for a Commercial Insurance Company, Tricare, MAC, or organizations performing similar functions, preferred.
• At least five years’ experience of provider professional billing, coding, and documentation practices in an outpatient setting, DME, home health, infusion, or hospice to Commercial Insurance Companies, Medicare, Medicaid, Tricare, or organizations performing similar functions, highly desirable.
• Familiarity in quality assurance for internal compliance of billing practices.
• Clerical experience dealing with any aspect of: ICD-10, CPT-4 or HCPCS coding.
• Experience using Microsoft Excel and other Microsoft Office applications.
Benefits
• Machinify offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, HSA/FSA options, life insurance coverage, 401(k) savings plans, family/parental leave, paid holidays, as well as paid time off annually.
Physical Requirements & Additional Notices
• If working in a hybrid or fully remote setting, access to reliable, secure high-speed Internet at your home office location is required.
• Regularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a computer mouse.
• Regularly reads and comprehends information in electronic (computer) or paper form (written/printed).
• Regularly sit/stand 8 or more hours per day.
• Occasionally lift/carry/push/pull up to 10lbs.
Apply Now
Apply Now
Role Description
The focus of the Healthcare Documentation Auditor is the performance of timely and effective reviews to assess documentation and billing accuracy for post and prepayment claims on behalf of Government and Commercial Payers.
• Review medical records for services billed and validate required documents and information is contained within the records submitted for various service types as required by clients.
• Applying local coverage determination (LCD), national coverage determination (NCD), and commercial payer policy to services in review.
• Document and articulate review findings and reference the appropriate policies and rules in the audit platform and as rationale language.
• Working collaboratively with the audit team to identify vulnerabilities and/or cases subject to potential abuse.
• Keep abreast of changes in technology and regulatory issues that may affect our business and clients.
• Suggest ideas that may improve audit workflows.
• Participate in the development of Review Guidelines and meetings as necessary.
• Cross-train in other audit types/focus areas or management teams as applicable.
• Maintain required quality and productivity standards.
• Performs other duties as assigned.
Qualifications
• Familiarity with insurance programs, particularly the coverage and payment rules, and audit types to validate against orders, units, and signatures.
• Demonstrated knowledge of medical terminology.
• Ability to maintain high-quality work while meeting strict deadlines.
• Excellent written and verbal communication skills.
• Experience using the following applications is preferred: Word, Excel, and e-mail.
• Must be able to independently use standard office computer technology (e.g., email, telephone, copier, etc.) and have experience using a platform to review and document findings.
• Must be able to manage multiple assignments effectively, organize and prioritize workload, problem solve, work independently and with team members.
• Courteous, professional, and respectful attitude.
• Flexibility to handle any non-standard situations that may arise.
Requirements
• High School Diploma or GED is required. Some college is preferred.
• At least two years’ experience in adjudicating/examining claims for a Commercial Insurance Company, Tricare, MAC, or organizations performing similar functions, preferred.
• At least five years’ experience of provider professional billing, coding, and documentation practices in an outpatient setting, DME, home health, infusion, or hospice to Commercial Insurance Companies, Medicare, Medicaid, Tricare, or organizations performing similar functions, highly desirable.
• Familiarity in quality assurance for internal compliance of billing practices.
• Clerical experience dealing with any aspect of: ICD-10, CPT-4 or HCPCS coding.
• Experience using Microsoft Excel and other Microsoft Office applications.
Benefits
• Machinify offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, HSA/FSA options, life insurance coverage, 401(k) savings plans, family/parental leave, paid holidays, as well as paid time off annually.
Physical Requirements & Additional Notices
• If working in a hybrid or fully remote setting, access to reliable, secure high-speed Internet at your home office location is required.
• Regularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a computer mouse.
• Regularly reads and comprehends information in electronic (computer) or paper form (written/printed).
• Regularly sit/stand 8 or more hours per day.
• Occasionally lift/carry/push/pull up to 10lbs.
Apply Now
Apply Now