Senior
659 RGH Enterprises, LLC · US-Nationwide-FIELD · Remote
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Supervise an audit team reviewing clinical documentation and responding to payer and regulatory audit requests for healthcare claims.
Worth knowing: Handles TPE CERT RAC pre and post payment audits and recoupments
Remote Hours: Monday - Friday, 8:00 AM - 5:00 PM EST (or based on business needs) What Revenue Cycle Management (RCM) contributes to Cardinal Health Revenue Cycle Management (RCM) is responsible for managing the financial lifecycle of patient accounts and ensuring timely and accurate payment for services provided. This job family is focused on a series of clinical and administrative processes that healthcare providers utilize to capture, bill, and collect patient service revenue in a manner that is compliant with payer rules and requirements. The revenue cycle shadows the entire patient care journey and begins with patient intake and ends when the patient’s account balance is zero. This team also encompasses a payer administration function that ensures we are successfully operationalizing payer rules and requirements as well as facilitating payer relations and escalation efforts. Responsibilities Will be responsible for overseeing the Audit team and responding to all audit requests received by the company in a timely manner in addition to developing and implementing audit processes. The role will focus on quality assurance, quality improvement, and collaborative activities to support company compliance initiatives in accordance with Federal and State regulations. Lead dedicated team responsible for reviewing validity of clinical documentation for accuracy and compile response packets for successful audits. Will work with any additional team members to ensure all tasks are completed in a timely manner and to the highest standards possible. Will provide feedback on successes and failures on a monthly recurring basis and cover areas related to all audit or recoupment inquiries, payor collections inconsistencies, as well as business operations policies and procedures. Oversee all aspects of a TPE, CERT, RAC, pre/post payment, or 3rd party audit & respond in required time frame. Oversee all aspects of a Recoupment or Refund request and respond in required time frame. Monitor, track, and trend all current, in progress, and completed audits. Gather and review all documentation for audits, recoupments, or other documentation requests from insurance companies for accuracy and submission approval. Ensure good communication with CMS and/or other auditors regularly about issues or concerns that arise.
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