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Underpayment Auditor

Job ID: 4657916
Updated: October 5, 2018
Geographic Location: 
Department: Denials Underpayments
Full/Part Time: 
Shift: 
Standard Hours: 0
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Job Summary

This position is located onsite with Mercy Health, a client of Ensemble Health Partners. To learn more about Mercy, click the link below to apply.

Underpayment Auditor:

The Underpayment Auditor performs payment variance deep dive and review activities related to the incorrect processing of claims across Ensemble Health Partners.

Job duties include, but are not limited to, understanding insurance contract terms, reviewing underpayments to determine if additional payment amounts can be requested, identifying trends in payment discrepencies amongst payors, auditing closed balance and write-off claims to ensure accuracy of payment to contract, reviewing contract terms for revenue capture and maximization per billing and coding guidelines, and working with contract management to identify opportunities when negotiating contracts with payors.

Underpayment Auditors' responsibilities include understanding insurance contract terms, reviewing underpayments to determine if additional payment amounts can be requested, identifying trends in payment discrepencies amongst payors, auditing correct payment amounts to ensure accuracy of contract, and working with contract management to identify opportunities when negotiating contracts with payors.

Underpayment Auditors review large amounts of remittance data and analyze utilizing databases and modeling tools to identify areas of payment variance to contract or revenue optimization opportunities and take steps (appeals, corrected claims, etc) to resolve and capture the contractual underpayments. Items identified are referred to the Underpayment Specialists for follow-up after identification and initial step to resolution.

Performs other duties as assigned

Qualifications - Minimum

Required Minimum Education: 2 Yr. Associates Degree, specialty/major: Business or relevant discipline

 

Minimum Years and Type of Experience: 1-2 years experience in healthcare industry.

 

Other Knowledge, Skills and Abilities Preferred: Experience in physician and hospital operations, compliance and provider relations.  Managed Care contracting experience preferred.

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Hours

Full-time, 40 hours per week, days

Equal Employment Opportunity

It is our policy to  abide by all Federal and State laws, as well as, the requirements of 41 CFR 60-1.4(a), 60-300.5(a) and 60-741.5(a), prohibiting discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibiting discrimination against all individuals based on their race, color, religion, sex, sexual orientation, gender identity, or national origin.

 

 

About Us

This position will be a part of the revenue cycle team at Ensemble Health Partners - a wholly owned subsidiary of Mercy Health. Ensemble Health Partners specializes in providing revenue cycle solutions and creating real value for its clients by building relationships, reducing revenue cycle spend and delivering exceptional results. Ensemble partners with hospitals across the United States to make real and lasting improvements that impact the bottom line.

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