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Senior Recovery Audit Analyst

Company: Commonwealth Health Corporation
Location: Bowling Green
Posted on: June 8, 2021

Job Description:

  • Position Summary
    Under limited supervision, provides an advanced level of technical support to receive and initiate the appeal process for requests received for all government and non-government claim recovery activities, including Recovery Audit Contractor (RAC), Additional Document Requests (ADRs), Hospitals Medicare Administrative Contractor (MACs), Medicaid Integrity Contractors (MIC), fiscal intermediaries and other payers. Maintains system data base and ensures data integrity. Uses advanced report writing skills to prepare statistical summaries and special ad hoc reports from various databases. Prepares statistical, claim analytics and audit summaries and special ad hoc reports from various databases. Initiates proactive voluntary audit processes.
  • Minimum Qualifications
    Work Experience
    • Four years of healthcare financial experience required.
    • Previous experience in hospital auditing, coding, patient accounting, reimbursement and/or compliance preferred.

    Education
    • Bachelors degree in Health Care Administration, Business Administration or Information Technology or related field required.

    Certifications/Licensure
    • None required.
  • Job Specific Performance Standards
    The duties listed below are a summary of the major essential functions of this position. The position may require other duties, both major and minor, that are not mentioned, and specific functions may change from time to time.
    • Receives and initiates the appeal process for requests received by Recovery Audit Contractors (RAC), Medicare Administrative Contractors (MAC), Medicaid Integrity Contractors (MIC), Fiscal intermediaries and other payers. Plans and coordinates department compliance audits to include risk areas, published contractor audits and summaries based on published RAC audit activity. Responsible for audit standards and key indicators by tracking and follow-up of requested information to meet associated deadlines. Monitors, coordinates and prepares appeal process activities to ensure timely response.
    • Develops and implements programs to insure the maintenance of integrity of data contained in the Revenue Integrity systems. Conducts audits of data entry into the system and works to ensure the accuracy of information. Validates billing, coding and reimbursement data for system analysis.
    • Under limited supervision, maintains the Revenue Integrity Compass program to support the appeal function for the organization. Analyzes data and workflow to integrate procedures in support of appeal administration and projects. Develops goals and processes to accomplish integration and extend functionality of applications.
    • Provides pre-emptive technical support and leadership to initiate voluntary audit processes. Actively participates in problem identification and resolution and provides high-level guidance, assistance and issue resolution.
    • Provides technical oversight and guidance to ensure internal controls are adequate and appropriately documented.
    • Uses advance report writing skills and data access skills to prepare customized reports, statistical summaries and special ad hoc reports for departmental employees, Management, and Executives with very short lead times. Continually monitors information needs and provides recommendation for new or modifications to existing systems to meet changing requirements.
    • Provides financial outcome summary reporting within the audit tracking software and management database. Coordinates data reporting with departments of Compliance, HIM, Finance and Recovery Audit Committee.
    • Proactively audits, trends and analyzes the audit process. Develops executive dashboards and scorecards to assist in the review process.

Keywords: Commonwealth Health Corporation, Bowling Green , Senior Recovery Audit Analyst, Other , Bowling Green, Kentucky

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