Pre-Claim Review Audit Specialist

EMPOWER

Pre-Claim Review Audit Specialist

Richardson, TX
Full Time
Paid
  • Responsibilities

    GENERAL PURPOSE:

    Responsible for the pre-claim review process including auditing components of medical records but not limited to

    performing the billing audit and performing quality assurance audits to ensure accurate billing.

    ESSENTIAL FUNCTIONS:

    • Accountable for billing audits and clinical quality assurance audits.

    • Ensures all functions are completed in compliance with federal, state, and local laws.

    • Utilizes EMR or other systems to monitor status of billed and unbilled accounts.

    • Completes audit workflow in EMR.

    • Provides collaboration with the Billing team and Compliance teams.

    • Ensures proper controls are adhered to for accuracy and timeliness of billing.

    • Actively contribute to special projects and offers feedback/suggestion to improve process.

    • Escalates issues/problems timely to Supervisor.

    • Interacts with a variety of personnel in the branch to achieve outcomes.

    • Contributes to Empower Services and Revenue Cycle department goals by accomplishing related duties as

    required.

    • Additional duties as assigned by supervisor and leadership.

    Minimum Education & Experience Requirements:

    • Associate degree in related field or equivalent work experience.

    • Minimum five (5) years healthcare billing experience inclusive of managed care or

    • One (1) year in a leadership role providing training, support, and direction.

    • Previous supervisory experience a plus.

    Knowledge, Skills & Abilities Required:

    • In-depth knowledge of healthcare industry billing.

    • Detail oriented with strong organization, analytical and problem-solving skills.

    • Proficient with software and systems.

    • Excellent communication and interpersonal skills.

    • Occasional same-day travel for meetings and conferences.

    Working Conditions & Physical Effort:

    • Work is normally performed in a typical interior/office work environment.

    • Ability to work flexible schedule and/or evening hours as needed.

    • Sits most of the time; infrequent to occasional walking or standing.

    • Ability to sit in front of CPU for long periods of time.

    • Ability to travel as needed.

    • Physical activity is sedentary and may require occasional lifting or carrying up to 10 lbs.