[Hiring] Claims Audit Supervisor @Cardinal Health

Role Description

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.

• Oversee the Audit team and respond to all audit requests received by the company in a timely manner.
• Develop and implement audit processes.
• Focus on quality assurance, quality improvement, and collaborative activities to support company compliance initiatives in accordance with Federal and State regulations.
• Lead a dedicated team responsible for reviewing the validity of clinical documentation for accuracy and compile response packets for successful audits.
• Work with team members to ensure all tasks are completed in a timely manner and to the highest standards possible.
• Provide feedback on successes and failures on a monthly recurring basis covering areas related to all audit or recoupment inquiries, payor collections inconsistencies, and 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.
• Ensure audits, both external and internal, meet all legal requirements and company policies.
• Review and timely release of all claims marked for QA Review on hold.
• Assist with the development of company policies and procedures and enforce compliance.
• Perform extensive reviews of accounts to determine if correct payments were made to providers.
• Review provider contracts/fee schedules to determine correct payment methodology.
• Prepare reports summarizing findings and recommending corrective action.
• Stay up to date on current industry standards and regulations and serve as subject matter expert for Medicare updates and educational trainings.
• Perform other duties as assigned.

Qualifications

• 4-8 years of experience, preferred
• Bachelor's degree in related field, or equivalent work experience, preferred
• Leadership, project management, or supervisory experience preferred
• Urology or wound care product knowledge preferred

Requirements

• Coordinates and supervises the daily activities of operations or business staff
• Administers and exercises policies and procedures
• Ensures employees operate within guidelines
• Decisions have a direct impact on work unit operations and customers
• Frequently interacts with subordinates, customers, and peer groups at various management levels
• Interactions normally involve information exchange and basic problem resolution

Benefits

• Medical, dental and vision coverage
• Paid time off plan
• Health savings account (HSA)
• 401k savings plan
• Access to wages before payday with myFlexPay
• Flexible spending accounts (FSAs)
• Short- and long-term disability coverage
• Work-Life resources
• Paid parental leave
• Healthy lifestyle programs