CorroHealth · 23 hours ago
Revenue Auditor 2, Zero Balance
United States
Full-time
Onsite
Mid Level
3+ years expCorroHealth is dedicated to helping clients achieve their financial health goals through scalable solutions and clinical expertise. The Revenue Auditor 2 is responsible for developing contract models, identifying insurance reimbursement issues, and conducting extensive reviews of hospital claim data to ensure accuracy and compliance.
AnalyticsFinanceFinancial ServicesFinTechHealth Care
Responsibilities
Create and update audit plans, including outlining potential risk areas of a hospital-payer contract based on reimbursement structure and how to manually identify within the data
Model and create/update pricing documents based on hospital contracts to calculate expected payments, including percentage of charge, per diems, MSDRG, outlier and/or stoploss, implants, drugs, Medicare, Medicaid, some outpatient, and other reimbursement models
Review insurance payments, research applicable sources (contracts, state and federal legislation, insurance payer policies, medical records, etc.) to determine if payment is correct and make recommendations on appropriate next steps
Identify contractual and clinical risk areas from commercial and government payors (e.g., Medicare, Medicaid) as well as other specialized audits (such as coordination of benefits and workers’ compensation)
Develop specifications and procedures to identify and troubleshoot contractual, coding, and administrative areas of underpayment risk using Access, SQL, Excel, and other programs
Conduct review of zero-balance hospital accounts to identify underpaid inpatient and outpatient claims
Present clear documentation of process, findings, and results of audits
Make recommendations to improve internal processes and external client contracts/processes
Work with data analyst team to build and validate pricing models
Work across project teams to research and outline next steps on identified underpayment trends
Other duties as assigned
Qualification
Required
High School Diploma or equivalent required
Minimum of 3 years of experience working with large sets of (healthcare) data
Minimum of 2 years of experience in areas of research and analysis
Minimum of 2 years of experience with managed care contracts (government and commercial) and hospital reimbursement
Minimum of 2 years of experience working with inpatient claims
Minimum of 1 year of experience working with Medicare, Medicaid, outpatient facility claims
Minimum of 1 year of experience with contract modeling
Ability to translate complex contract language and healthcare data into actionable information and insights
Ability to work independently to solve problems and recommend technical solutions (ex. provide calculation/formula to price in Alteryx)
Intermediate Excel skills, including knowledge of complex formulas and functions (CONCATENATE, IF, pivot tables)
Basic knowledge of Access (link tables, select/update query, manipulate data in tables) and SQL preferred
Strong verbal and written communication skills
Strong organization skills and attention to detail
Preferred
Basic knowledge of Access (link tables, select/update query, manipulate data in tables) and SQL preferred
Company
CorroHealth
CorroHealth is a provider of revenue cycle management solutions for healthcare organizations, including health systems, and health plans.
10001+ employees
Funding
Current Stage
Late StageTotal Funding
$376.27MKey Investors
Patient Square Capital
2024-10-24Private Equity
2023-10-05Private Equity· $50M
2022-05-17Series Unknown· $16.6M
Leadership Team
Patrick Leonard
Chief Executive Officer
Becky Blake
Chief People Officer
Recent News
Company data provided by crunchbase