Job Description

Summary

Under the general direction of the VP, Revenue Cycle, the RCM Audit Specialist facilitates the review of medical claim submission in accordance with state, federal, and payer guidelines to ensure best-in-class services to the patients of CSI Pharmacy.

Essential Duties and Responsibilities

include the following. Other duties may be assigned, as necessary.

• Set up and ongoing monitoring of Insurance files in Care Tend and Monday.com
  • Accurate payer notes for intake, billing and collection teams
  • Accurate and timely updating of expected reimbursement rates
  • Accurate set up of Per Diem and billing rules for each payer.

• Complete commercial and government payer audits in a timely manner.
• Waystar payer set up and resolve denials for payer matching.
• Perform a percentage of quality audits on a pre and post bill basis.
• Perform review on all government denials due to billing errors.
• Implement audit approaches including scope and statistical sampling methodologies.
• Communicate reimbursement changes to leadership in a timely manner
• 
  Assist in the development and training and education for billing, collection and credit management teams.
• Ongoing employee training and assessment reviews collaborating with management to achieve set goals and objectives.
• Effectively prioritize and complete all assigned tasks.
• Performs in accordance with system-wide competencies/behaviors.
• Conduct duties in a professional and timely manner.
• Assist in other areas of the revenue cycle process as required.
• Comply with Company’s Core Values and Core Competencies
• Perform other duties as assigned by supervisor

Qualification Requirements

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Effective communication skills
• Knowledge and understanding of home infusion revenue cycle
• Strong working knowledge about compliance and regulatory guidelines including but not limited to an awareness of trending federal audit targets based on claim errors.

NOTICE: Successful completion of a drug screen prior to employment is part of our background process, which includes medical and recreational marijuana.

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By submitting your application, you are confirming that you are legally authorized to work in the United States.

JR# JR248297