Apply on Employer Site

FMOL Health · 2 months ago

Managed Care Auditor

Monroe, LA

Full-time

Onsite

Mid Level

3+ years exp

Franciscan Missionaries of Our Lady Health System is seeking a Managed Care Contract Auditor to ensure the accuracy of payments from Managed Care companies for hospital services. This role involves auditing payment processes, reporting results to improve internal operations, and collaborating with various departments to resolve billing issues.

Health Care

Responsibilities

Audit Analysis and Reporting

Audits report from decision support system to compare expected payments with actual payments. Compares contract terms to payment to determine appropriate billing, timeliness, and accuracy of payment

Specifies, produces, and analyzes a standard set of utilization and medical expense reports to support the assessment and cost effectiveness of managed care contracts. Maintains report showing audit results and communicates results of audits to Business Office and Managed Care Departments

Identifies trends related to specific payers and/or internal process problems that negatively impact hospital cash flow

Performs audits of inaccurately adjudicated accounts and reconciles to the contract and corresponding explanation of benefits

Collaboration and Partnership

Assists with issues identified related to contract modeling, billing, registration, denials, etc

Works collaboratively with the Managed Care Operations Coordinator to resolve identified issues with managed care companies

Coordinates and reports audit outcome regarding payment errors, percentage of savings or losses, and works closely with the assigned collection staff and Business Office for process improvement and account follow up

Promotes the quality and efficiency of his/her own performance through participation in staff educational programs, approved continuing education courses, and specialized skill training programs

Other Duties As Assigned

Performs other duties as assigned or requested

Qualification

Health care billingClaims adjudicationProcess improvementCollaboration

Required

At least 3 years' experience in health care billing/claims adjudication

High School or equivalent

Company

FMOL Health

FMOL Health is a bold, connected health system that delivers care that prioritizes people – every patient, every community, every time – while honoring the unique character of each market we serve.

Founded in 1984

Baton Rouge, Louisiana, USA

10001+ employees