Revenue Integrity Reimbursement Auditor

Job Description

Baptist Health is looking for a Revenue Integrity Reimbursement Auditor to join our team! This is a remote work position that requires residency in KY or IN

Research denials and/or suspected payment variances from all commercial and governmental payors, including audits RACs or similar Medicare and Medicaid programs. Analyzes Negotiated Payor Contract Terms and Payment Appendices, Provider Manuals, and Provider Policies / Bulletins, and understands modeled expected reimbursement methodology as it applies to the services rendered to Baptist Health patients.

Performs recovery efforts on reimbursement discrepancies monitoring the payor dispute / appeal, escalation to the Director / Manager, or Managed Care until resolution is achieved. Facilitates development of strategies after trends which negatively impact reimbursement are identified both at the corporate and/or facility level in order to improve reimbursement for Baptist Health System.

• Bachelor's degree with five years healthcare experience with two years in revenue cycle related area such as registration, patient financial services, or managed care.
• In lieu of bachelor's degree, eight years of healthcare experience required including five years in one of the revenue cycle related areas as listed above.
• Requires knowledge of medical terminology; payor reimbursement guidelines (authorization / notification, medical necessity, and timely filing guidelines); payor denial appeal / payment variance resolution processes; and managed care contracts. Individuals working with payor audits must have a keen understanding of all audit response requirements and timelines.

Baptist Health is an Equal Employment Opportunity employer.