Payer Auditor

Providence Health & Services Anchorage , AK 99501

Posted 1 week ago

Providence is calling a Payer Auditor (Revenue Cycle Integrity, Day, 1.0 FTE) to Providence Alaska Medical Center in Anchorage, Alaska. We are a community of caregivers delivering every day on our Mission to provide compassionate care that is accessible for all - especially those who are poor and vulnerable.

In this position you will:

  • Use knowledge of regulatory, statutory and policy requirements of payers, claim coding logic, accepted standards of care and clinical research to support the validity of the claims.

  • Collaborate with the Senior Payer Auditor to report trends and recommend operational improvements.

  • Act as a subject matter expert to clinicians and administrative staff regarding regulatory, statutory and policy related reimbursement requirements of multiple payers.

  • Organize and prioritize assigned work and schedule time to accommodate work demand, turnaround time requirements and commitments.

  • Understand and comply with policies and procedures related to medical legal matters, including confidentiality, amendment of medical records, release of information, patient rights, medical records as legal evidence, informed consents, etc.

Required qualifications for this position include:

  • 1 year work experience or equivalent with:

  • Healthcare auditing experience involving the interpretation and application of various regulatory, statutory, clinical policy bulletins and other payer requirements related to reimbursement and standards of care

  • Reconciliation of healthcare claims to assure accuracy and appropriateness of charges

  • Appeal or technical writing experience with demonstrable ability to incorporate relevant research and regulatory requirements

  • Electronic medical records

  • Quality Improvement methodologies, including Analysis, Measuring, Tracking, Trending, Reporting and Sustaining Outcomes; and,

  • Direct patient care or experience as an allied health position within the acute care setting

  • Advanced knowledge pertaining to:

  • Regulatory, policy and statutory requirements relating to healthcare reimbursement;

  • Payer appeal processes, timeliness and filing requirements;

  • Appropriate resource utilization based on accepted standards of care;

  • Standards for healthcare auditing and professional codes of conduct; and,

  • UB Claim format and coding logic (CPT, HCPCS, ICD9/10, Condition, Occurrence, and Value codes)

  • Advanced persuasive and technical writing skills

  • Advanced proficiency with multiple software applications including: Word, Excel, Publisher, VISIO, Tableau and Access or other database systems.

  • Ability to apply statistical analysis related to research findings and internal performance assessments

Preferred qualifications for this position include:

  • Bachelor's Degree with healthcare related major

About Providence Alaska Medical Center

Providence Health & Services Alaska is among nation's best employers for healthy lifestyles! The National Business Group on Health, a non-profit association of large U.S. employers, has honored Providence Alaska for its commitment and dedication to promoting a healthy workplace and encouraging our caregivers (employees) and families to support and maintain healthy lifestyles. Mountain-Pacific Quality Health has awarded Providence Alaska Medical Center with its Quality Achievement Award for high-quality care in the areas of heart attack, heart failure, pneumonia and surgical infection prevention. This is the highest honor awarded by Mountain-Pacific.

As the state's largest hospital, Providence Alaska Medical Center provides full-service, comprehensive care to all Alaskans, a role unmatched by any other in the state. Within our community, you will find top notch ski resorts, kayaking, and wildlife. Enjoying the outdoors is just one of many reasons to live in and explore Alaska!

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Payer Auditor

Providence Health & Services