Job Description

Under the general direction of the Senior Contract Administrator the Third-Party Audit Coordinator is responsible for coordinating all non-government health plan audits for Brown University Health and its affiliates. Perform preliminary scoping/investigative research of contract audit concerns assess issues and provide feedback regarding audit approach including methods and time frames. Responsible for the input of all third-party payer audit letters complex review letters prepay letters demand letters and other correspondence from the health plan. Responsible for preparing and maintaining an audit tracking database with the letters and gathering information needed for review of the cases. Ensure Medical Records staff is notified in order to ensure timely receipt of medical records requested for review. Update the audit database with payment information as it becomes available. Responsible for the maintenance of access to payer websites on behalf of the enterprise following security guidelines.

Responsibilities:
Develop and maintain understanding of current third-party payer (Blue Cross Blue Shield of RI Tufts Health Plan United Healthcare etc.) contracts in order to consistently apply health plan audit terms in accordance with contract language. Routinely acquire information on changes to various third-party payer contracts and participate in development of internal procedures to respond to same. Assess operational compliance to procedures in various affiliate departments in order to maximize accuracy and completeness of charges and codes submitted for payment. Communicate findings to individual departments.

Coordinate all aspects of third-party payer audits with both internal and external representatives. Representatives include payers outside audit companies medical records departments (all affiliates) coding departments (all affiliates) patient financial services and contracting. Maintain effective professional oral and written communications with third-party payer audit officials. Obtain when necessary assistance from departments as needed. Assist with facilitating education programs for medical staff department heads managers and their staff to ensure contract compliance. Develop and maintain working relationship with Brown University Health affiliate departments as needed to ensure full data exchange. Serve as a resource for adherence to audit function.

Coordinate and schedule audit start-dates receive letters and correspondence from health plans related to audit obtain listing of selected accounts from payers and provide to medical records departments obtain medical records and provide to payer/outside auditor obtain letter of audit findings from payer and communicate to coding department obtain appeal letters from coding department and send to payer/outside auditor initiate third-party reviews with payers. Assure all functions are performed within the timeframes outlined in the payer contract.

Maintain a Master List of all third-party payer audits for tracking purposes including all applicable dates (i.e. initiation date audit start date etc.) monitor and inform of upcoming due dates. Maintain logs of all accounts with findings by payer/outside auditor for all third-party payer audits (logs to include account numbers dates of services billed DRG agree/disagree status etc.).

Prepare and provide financial analysis of payer audits to management. Assist in tracking risks to the organization including but not limited to assisting the Reimbursement Department with analyzing third-party liabilities. Assist with maintaining documents reports correspondence specifications and other data related to studies and analyses. Analyze data to identify issues or circumstances contributing to payment and/or write-off recovery. Prepare summaries of factual findings and recommendations; ensures audit documents are complete and current.

Perform special projects related to audit (i.e. summarize data types of requests findings & trend analysis etc.) as assigned.

Meet with Senior Contract Administrator regularly and raise any issues & recommend resolutions in a timely manner so as to not cause delays in the process or timeframes to not be met. Make recommendations for improvements in the audit process. Recommend enhancement of contract language as appropriate. Participate in meetings as required.

Perform other duties as assigned by Senior Contract Administrator.

Other information:EDUCATION/EXPERIENCE:
Bachelors Degree in Business Finance or Health Administration preferred but not required. At least five years of experience in healthcare revenue cycle medical insurance or medical coding auditing or accounting.

Proficient in use of Microsoft Excel and Outlook.

SKILLS QUALIFICATIONS:
General understanding of provider reimbursement methodologies and contracts

Knowledge of audit reviews and processes knowledge in analysis of medical records medical terminology and coding

Familiar with hospital and physician coding charging billing and collection procedures

Knowledge/experience with hospital and physician clinical information/electronic health systems (documentation billing scheduling registration etc.)

Good project management problem solving and analytical skills

Strong organizational skills with a high level of accuracy and attention to detail

Ability to multi-task and meet deadlines under pressure

Ability to work both independently and in a team environment

Experience with working with other departments

Proficient use of various word processing and spreadsheet packages

Excellent/efficient written and oral communication skills

Ability to manage projects with multiple different groups and documents

Ability to make independent decisions and manage group processes to ensure success

Knowledge of Medical terminology procedure and diagnosis coding

Ability to read UBs HCFAs and EOBs

WORK ENVIRONMENT AND PHYSICAL REQUIREMENTS:
Work is performed in a typical office setting.

SUPERVISORY RESPONSIBILITY:
None

Brown University Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status. Brown University Health is a VEVRAA Federal Contractor.

Location: Brown University Health Corporate Services USA: RI: Providence

Work Type: Full Time

Shift: Shift 1

Union: Non-Union

Test

Summary:
Under the general direction of the Senior Contract Administrator the Third-Party Audit Coordinator is responsible for coordinating all non-government health plan audits for Brown University Health and its affiliates. Perform preliminary scoping/investigative research of contract audit concerns assess issues and provide feedback regarding audit approach including methods and time frames. Responsible for the input of all third-party payer audit letters complex review letters prepay letters demand letters and other correspondence from the health plan. Responsible for preparing and maintaining an audit tracking database with the letters and gathering information needed for review of the cases. Ensure Medical Records staff is notified in order to ensure timely receipt of medical records requested for review. Update the audit database with payment information as it becomes available. Responsible for the maintenance of access to payer websites on behalf of the enterprise following security guidelines.

Responsibilities:
Develop and maintain understanding of current third-party payer (Blue Cross Blue Shield of RI Tufts Health Plan United Healthcare etc.) contracts in order to consistently apply health plan audit terms in accordance with contract language. Routinely acquire information on changes to various third-party payer contracts and participate in development of internal procedures to respond to same. Assess operational compliance to procedures in various affiliate departments in order to maximize accuracy and completeness of charges and codes submitted for payment. Communicate findings to individual departments.

Coordinate all aspects of third-party payer audits with both internal and external representatives. Representatives include payers outside audit companies medical records departments (all affiliates) coding departments (all affiliates) patient financial services and contracting. Maintain effective professional oral and written communications with third-party payer audit officials. Obtain when necessary assistance from departments as needed. Assist with facilitating education programs for medical staff department heads managers and their staff to ensure contract compliance. Develop and maintain working relationship with Brown University Health affiliate departments as needed to ensure full data exchange. Serve as a resource for adherence to audit function.

Coordinate and schedule audit start-dates receive letters and correspondence from health plans related to audit obtain listing of selected accounts from payers and provide to medical records departments obtain medical records and provide to payer/outside auditor obtain letter of audit findings from payer and communicate to coding department obtain appeal letters from coding department and send to payer/outside auditor initiate third-party reviews with payers. Assure all functions are performed within the timeframes outlined in the payer contract.

Maintain a Master List of all third-party payer audits for tracking purposes including all applicable dates (i.e. initiation date audit start date etc.) monitor and inform of upcoming due dates. Maintain logs of all accounts with findings by payer/outside auditor for all third-party payer audits (logs to include account numbers dates of services billed DRG agree/disagree status etc.).

Prepare and provide financial analysis of payer audits to management. Assist in tracking risks to the organization including but not limited to assisting the Reimbursement Department with analyzing third-party liabilities. Assist with maintaining documents reports correspondence specifications and other data related to studies and analyses. Analyze data to identify issues or circumstances contributing to payment and/or write-off recovery. Prepare summaries of factual findings and recommendations; ensures audit documents are complete and current.

Perform special projects related to audit (i.e. summarize data types of requests findings & trend analysis etc.) as assigned.

Meet with Senior Contract Administrator regularly and raise any issues & recommend resolutions in a timely manner so as to not cause delays in the process or timeframes to not be met. Make recommendations for improvements in the audit process. Recommend enhancement of contract language as appropriate. Participate in meetings as required.

Perform other duties as assigned by Senior Contract Administrator.

Other information:EDUCATION/EXPERIENCE:
Bachelors Degree in Business Finance or Health Administration preferred but not required. At least five years of experience in healthcare revenue cycle medical insurance or medical coding auditing or accounting.

Proficient in use of Microsoft Excel and Outlook.

SKILLS QUALIFICATIONS:
General understanding of provider reimbursement methodologies and contracts

Knowledge of audit reviews and processes knowledge in analysis of medical records medical terminology and coding

Familiar with hospital and physician coding charging billing and collection procedures

Knowledge/experience with hospital and physician clinical information/electronic health systems (documentation billing scheduling registration etc.)

Good project management problem solving and analytical skills

Strong organizational skills with a high level of accuracy and attention to detail

Ability to multi-task and meet deadlines under pressure

Ability to work both independently and in a team environment

Experience with working with other departments

Proficient use of various word processing and spreadsheet packages

Excellent/efficient written and oral communication skills

Ability to manage projects with multiple different groups and documents

Ability to make independent decisions and manage group processes to ensure success

Knowledge of Medical terminology procedure and diagnosis coding

Ability to read UBs HCFAs and EOBs

WORK ENVIRONMENT AND PHYSICAL REQUIREMENTS:
Work is performed in a typical office setting.

SUPERVISORY RESPONSIBILITY:
None

Brown University Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status. Brown University Health is a VEVRAA Federal Contractor.

Location: Brown University Health Corporate Services USA: RI: Providence

Work Type: Full Time

Shift: Shift 1

Union: Non-Union

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