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Titan Healthcare Management Solutions Revenue Cycle Auditor - Tucson in Tucson, Arizona

Company OverviewTitan Health Management Solutions (Titan) has been in operation since 2002 and has grown dramatically through it?s use of personnel expertise and technology. Titan specializes in zero balance auditing and recovery, but offers other revenue cycle services as well. We pride ourselves on offering exceptional results and industry class service to our clients. Our unique business model and expertise has allowed us to rapidly expand into other markets and other lines of business.Job SummaryTitan is looking for motivated self-starters who enjoy thinking and working independently. We are looking for problem solvers and inquisitive minds. We provide a professional work environment where you will be expected and rewarded to perform well. The Medical Claims Auditor is responsible for audit of paid or denied ?zero balance? and other assigned hospital medical insurance claims, identification and verification of underpayments, preparation of appeals/grievances to the insurance plan for accurate payment, and assistance with the collection and resolution of their appeals. The Medical Claims Auditor serves as subject experts on their assigned plan contracts as well as on coding and reimbursement standards.

Responsibilities and Duties

  • Actively pursues and identifies advanced audit tactics, trends, and opportunities, and assists the Supervisor in implementing these tactics to maximize revenue identification

  • Assists the supervisor in managing workflows

  • Requires direct client interfacing, including off-site training, and attendance at client update meetings

  • Facilitate the identification and communication of new audit and reimbursement trends, opportunities, and audit tactics

  • Identification of missed opportunities, and communication of these to Supervisor

  • Analysis of specific payors, including contract language, to prospectively identify effective collection tactics

  • Assist management with legal cases, state fair hearings, formal appeals and grievances

  • Assist Supervisor with distributing work queues and managing team volumes

  • Assist Supervisor with gathering data and auditing individual auditor work for use in quality assurance audits and performance reviews

  • Comprehensive audit of hospital insurance claims payments, including reference to contract payment terms, Medicare and Medicaid coding rules, authorizations, and generally accepted coding and claims payment standards. Audit includes all necessary research to correctly verify claim payment accuracy or denial legitimacy, including telephonic communication with plan where necessary

  • Analysis of contract language to prospectively identify potential sources of payment error

  • Identification and verification of underpayments made to hospital by insurance plan

  • Formulation of appeal/grievance reason and argument logic, including accurate calculation of short paid amount

  • Serve as technical expert for coding and appeal questions for Titan and Client.

  • Data entry and tracking of appeal and underpayment information into Titan applications and into Client claims system notes as appropriate

  • Assistance with submission of appeal letters, including drafting appeal letter language and/or phone/fax/email appeal as required

  • Identification and submission of materials (including corrected claims) required by payor for resolution of appeal/grievance

  • Review of denials, partial pays, and payment discrepancies to validate accuracy of initial appeal. Escalate appeals to higher level as appropriate. Includes telephonic/fax/email communication with plan where appropriate

  • Audit of paid appeal amounts to verify complete payment. Draft and submit escalated or secondary appeal as required for underpaid accounts.

  • Assist with collection of appeals, including telephonic communication with plan in cases where that would result in faster or more accurate payment of the appeal.

Qualifications and Skills

  • High School Diploma or equivalent required

  • 2-year associate degree preferred with health care focus as a plus (Health Information Technology, Health Management, or the like)

  • GPA of B equivalent is preferred

  • CPC and/or COC active certification required

  • Hospital coding certification preferred (COC or CIC)

  • 3-5 years of experience in medical billing and/or coding

  • CPT coding for at least 2 years required

  • Diagnosis coding (ICD10) for a minimum of 2 years required

  • Minimum 1-year experience in medical claims auditing

  • Experience in payor contract analysis required ? commercial and government

  • Detailed working knowledge of Commercial, Medicare and Medicaid claims

  • Detailed working knowledge of hospital/facility billing and coding rules and guidelines

  • Customer and Client services experience

  • Excellent oral and written communication skills

Office Location: 2500 N. Pantano Rd, Tucson AZ

Salary: $17.00 to $22.00 hourly

Work Schedule: Flexible hours to be arranged with site manager and business requirements.