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UofL Health · 2 weeks ago

Insurance Reimbursement Auditor, 250 E. Liberty St, Potential Remote

United States

Full-time

Remote

Entry, Mid Level

2+ years exp

UofL Health is seeking an Insurance Reimbursement Auditor responsible for reviewing paid insurance claims and ensuring reimbursement accuracy according to contracted rates. The role involves follow-up with various payers, conducting root cause analysis, and identifying revenue opportunities to enhance reimbursement for UofL Health facilities.

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Responsibilities

Perform thorough research of paid claims (including $0.00 pay) for appropriate follow up with payer

Provide detailed analysis of findings and payer trends

Review claim remittances to determine reimbursement rates and methodologies used by the payer when processing the claim

Identify opportunities with underpayment or contract language that is determinant to reimbursement and report findings to leadership

Perform extensive review of high dollar accounts that are subject to alternative reimbursement terms to validate payments are in accordance with contracted rates

Responsible for reviewing and understanding explanation of benefits/remittance advice from third-party payers

Process and review incoming correspondence from payers related to underpayment or high dollar/outlier payment discrepancies

Audit, research accounts, payment posting, and contractuals to confirm the accuracy of the balance, financial class, and follow up schedule on the account

Phone contact with patient, physician office, attorney, etc. for additional information to provide payer in order to process claim in accordance with contracted rates

Communicate payment discrepancies to payer specific provider representatives via email, phone, or scheduled in-person meetings

Work with reimbursement and contract modeling team members to verify contracted rates are properly calculated with contract modeling system

Maintain regular contact with Managed Care & Contracting management team to ensure all new contract agreements/updated rates are received timely and effective dates for new rates are communicated to the appropriate Revenue Cycle teams

Prepare and submit letters, emails, faxes, online inquiries, appeals, and adjustments

Document all follow up efforts in a clear and concise manner into the AR system

Work assigned accounts as directed while reaching daily productivity goals

Complete tasks by deadline provided by leadership

Participate in system testing and training

Attend seminars as requested

Other duties as assigned

Qualification

Insurance claim analysisICD-10 knowledgeCPT-4 knowledgeMS Excel proficiencyEOB processingOrganizational skillsCommunication skillsTeam playerSelf-motivation