PFS Auditor, Remote

PFS Auditor, Remote

Join to apply for the PFS Auditor, Remote role at Ambry Genetics

Compensation
$30.00 - $35.00 an hour per year. You are eligible for a Short-Term Incentive Plan with the target at 5% of your annual earnings; terms and conditions apply.

The PFS Auditor works with PFS management, attorneys and claims representatives by reviewing and appealing claims when appropriate to overturn clinical validation and coding denials from Medicare, Medicaid, and other third-party payers.

• Conducts SOX reviews by assessing internal controls and auditing billing processes
• Conducts pre and post billing reviews to ensure quality standards are met prior to billing. Completes assignments in a manner that meets the quality assurance goal of 100% accuracy.
• Monitors the results of claims audit policies and procedures and reports findings to appropriate leadership.
• Utilizes Medicare and Contractor guidelines for coverage determinations. Utilizes extensive knowledge of medical terminology, ICD-10-CM, HCPCS Level II to conduct audits.
• Participates in pre‑ and post‑review meetings, providing support and recommendations for issues presented. Ensures past review recommendations are implemented in current review process.
• Provides broad-based knowledge in billing and collections, strong knowledge of industry practice and business principles to ensure department is compliant with all billing practices.
• Works in partnership with other departments for education on patient billing policies and process improvements.
• Other duties as assigned

• CPC or CPMA preferred
• Associate’s degree preferred
• Knowledge of CPT codes, medical terminology, insurance plans, ICD-10 codes
• Strong ability to adapt to a fast-paced, dynamic environment

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Entry level

Full-time

Accounting/Auditing and Finance