Audit Coordinator

Audit Coordinator

This position is responsible for the coordination of external reviews / audits, including but not limited to Medicare RAC, Medicaid RAC, or successor organizations; Medicare and / or Medicaid pre and / or post documentation requests, including but not limited to ADR, CERT, area wide and / or probe reviews.

This includes but is not limited to establishing workflows, policies and procedures, software analysis and maintenance and implementation of processes and communication plans for the facility's interactions with third party auditors including but not limited to pre and post payment Medicare, Medicaid and their respective Recovery Audit Contractors (RAC) reviews to ensure timely completion or review / audit documentation requests.

This position is responsible for the oversight of all pre and post payment audit functions and is responsible for maintaining a tracking system for all audit activity throughout all levels of appeals.

The Audit Coordinator is responsible for the writing and submission of basic payer appeal, including review and submission of supporting documentation and regulations.

The Audit Coordinator will analyze review / audit findings, denials to identify problems in processes, get the information to key people to evaluate, including preparing and sending reports weekly to Chief Compliance Officer; VP Revenue Cycle; Medical Director Utilization Management; Director of Case Management and others as identified / assigned.

Must have clinical or patient accounting background with fundamental knowledge of the Revenue Cycle Process, which includes patient access, case management / utilization review, charge capture, HIM, patient accounting, billing and coding compliance.

In-depth familiarity with third party billing requirements, governmental regulations and billing documentation compliance requirements pertaining to hospital and ambulatory reimbursement.

Minimum of 1 years' experience coordinating third party audit review cycle from receipt of documentation request through finalizing results with payers and / or governmental agencies.

Experience writing and submitting basic payer appeal, including review and submission of supporting documentation and regulations.

Associate's degree or equivalent experience required; bachelor's degree preferred.

Coding certification, such as CPC, CPC-H, CCS, CCS-P, preferred.