Managed Care Contract Auditor - Government (Tricare, Medicare, Medicaid) (20193517)

Mcleod Health Florence , SC 29503

Posted 3 weeks ago

  • Maintains a professional image and exhibits excellent customer relations to patients, visitors, physicians, and co-workers in accordance with our Service Excellence Standards and Core Values.

  • Ability to manipulate data in spreadsheets in order to report trends and statuses to Director.

  • Analyze and interpret complex, managed care contracts, provider requirements and payment methodologies for hospital and physician reimbursement.

  • Investigate, determine, pursue, and overturn with accuracy and timeliness underpaid accounts by insurance payers. Thoroughness and reliability are essential because of the nature of the work and for credibility with the payers.

  • Negotiate and insist accountability with third party payers on accounts through accurate and timely follow-up.

  • Document precisely and timely in billing application and contract management software.

  • Utilize available resources (online websites, contract management software, payer contacts) to aid in the expedient recovery of underpaid funds.

  • Maintain a high level of professionalism while aggressively overturning underpaid claims by third party payers.

  • Must be flexible, able to work independently and able to achieve deadlines and deliverables with minimal supervision.

  • Perform other duties as assigned by Director.

Qualifications/Training:

  • Working knowledge of managed care terminology, managed care reimbursement methodologies

  • Working knowledge of Patient Financial Services. Experience working with governmental payers (Tricare, Medicare, Medicaid), Medicare Advantage payers, and Medicaid MCO payers preferred.

  • Procedural knowledge of account receivable management.

  • Understanding of basic revenue cycle

  • Excellent interpersonal, written and organizations skills

  • Attention to detail and accuracy skills required.

  • Experience with problem solving techniques.

Licenses/Certifications/Registrations/Education:

  • Minimum of a High School Diploma/GED from an accredited school
  • 6 years of experience in healthcare finance
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Managed Care Contract Auditor - Government (Tricare, Medicare, Medicaid) (20193517)

Mcleod Health