Stance Health Solutions, uniting SG Homecare and Western Drug · 1 month ago
Revenue Cycle Auditor
La Crescenta, CA
Full-time
Onsite
Entry, Mid Level
2+ years expStance Health Solutions is a company that unites SG Homecare and Western Drug, and they are seeking a Revenue Cycle Auditor. The role involves managing the revenue cycle by processing claims, resolving discrepancies, and ensuring timely collection of payments from insurance companies and patients.
Hospital & Health Care
Responsibilities
Process and submit insurance claims to various payers, ensuring accuracy in coding and billing information to minimize denials and delays
Review patient accounts to verify correct insurance billing information, update records as necessary, and resolve any discrepancies in patient account balances
Analyze denied claims to identify denial reasons and perform the necessary follow-up actions including appealing denied claims with appropriate documentation and justification
Analyze accounts receivable reports and take appropriate action to resolve repetitive denials
Coordinate with healthcare providers to obtain necessary medical documentation, referrals, or authorizations required for claim processing and reimbursement
Discuss areas needing improvement with the authorization and CMN departments as needed
Engage directly with patients to explain their bills, resolve billing inquiries, and set up payment plans for outstanding balances, ensuring a positive customer service experience
Engage in written communication and schedule meetings with payers to address aging balances
Compiles and submits projects to insurance companies
Meet with Revenue Cycle Manager and Director to discuss areas of concern
Process and submit authorization and CMN requests to medical groups, plans, and physicians’ offices. Follow-up in a timely manner
Process eligibility verification and determine payer, benefits, and coverage criteria
Monitor and report on key performance indicators related to revenue cycle activities, such as claim denial rates, time to payment, and outstanding accounts receivable, to identify areas for improvement
Work on complex and intricate revenue-related matters
Supports global team and provides feedback though QA, reviews and huddles
Monitors work completed by global partners and resolves tasks the global team cannot resolve
Submits price table, payer rule, and system configuration updates to designated team
Implement and adhere to compliance standards and regulations related to medical billing and coding, maintaining confidentiality of patient information in accordance with HIPAA guidelines
Participate in the development and testing of new billing software and systems to improve revenue cycle efficiency, including providing feedback on software performance and suggesting enhancements
Qualification
Required
Minimum of 2 years' experience in Revenue Cycle Management
High school diploma or equivalent required
Effective verbal and written skills
Knowledge in all major insurance carrier reimbursement guidelines and eligibility coverage and claims processing guidelines (Medicare, Medi-Cal, Commercial Health Plans)
Thorough understanding of healthcare regulations, coding guidelines, and payer policies/contracts
Able to work in a fast-paced environment, flexible and ability to adapt to changing environment
Strong interpersonal, communication, time management, and organizational skills for effectively conveying audit findings to payers as well as with domestic and global staff
Self-Starter with the ability to work independently
Proficiency with Microsoft Excel
Experience with Brightree EHR or other EHR system
In-depth knowledge of the practices, procedures, and concepts of the healthcare revenue cycle
Strong analytical and problem-solving abilities
Working knowledge of MS Office
Strong ability to analyze financial data, identify discrepancies, and conduct audits
Exceptional precision in reviewing documents and data for accuracy
Company
Stance Health Solutions, uniting SG Homecare and Western Drug
Stance Health Solutions is a patient-centric healthcare company that enables our customers to live comfortably at home by providing reliable services and innovative solutions for every stage and every age.
501-1000 employees
Funding
Current Stage
Late StageCompany data provided by crunchbase