Auditor, Revenue Cycle - Signature Health, Inc.

Auditor, Revenue Cycle

Are you looking for an organization where you can grow while making a positive impact on people's lives? At Signature Health, our purpose is to provide integrated healthcare for our community specializing in patients with mental illness and/or addiction because we want people to realize their highest potential.

Our core values are the foundation of who we are:

• People First mindset where we honor our colleagues and patients
• Striving for Excellence in our work each day
• Can Do approach where we roll up our sleeves in response to opportunities and challenges

In addition to a rewarding career, as a full-time employee, you will have access to the following employer/employee paid benefits:

Full Time:

• Medical, Dental, Vision
• Robust earned paid time off program (PTO)
• 401k match
• Various Life Insurance Options
• Short- and Long-Term Disability (Not applicable for school-based employees)
• Federal Loan Forgiveness Program (available on eligible on roles)
• HealthJoy - no cost medical and mental health online resources available Day 1 (coverage extends to family members living in the same household)
• Tuition & Professional Development Assistance

If you value the people around you, strive to be the best version of yourself and have a can do mindset, then Signature Health could be the best place for your next career. Read below on how you can make a difference in our community and apply today!

SCOPE OF ROLE

Reporting to the Director, Revenue Cycle the Auditor, Revenue Cycle is responsible for researching denials and/or suspected underpayments from payers, including pre-denial audits and analyzes fee schedules and contracts in order to determine if Signature Health received appropriate reimbursement. The Auditor, Revenue Cycle performs recovery efforts on reimbursement discrepancies and follows up until resolution.

HOW YOU’LL SUCCEED:

• Summarize and quantify issues by insurance payer including pertinent information needed to escalate to provider representative.
• Perform claim appeals as necessary to resolve erroneous claim denials as efficiently as possible.
• Review billing system errors to identify denial trends and offer recommendations for resolution.
• Perform analysis on claim underpayments as compared to contractual rates to determine common denominators and themes. Articulate and summarize findings for management.
• Conduct research, analyses, and provide recommendations on routine and non-routine problems.
• Review claim forms to identify any system configuration issues and promptly communicate to management.
• Reviews claim and payer rejections to identify and offer suggestions to mitigate future rejections.
• Perform research on payer denials, payment variances and configuration issues prior to submitting for manager review is essential.
• Conduct a high volumes of transaction and be able to parse data and summarize findings.
• Other duties as assigned.

KNOWLEDGE & EXPERIENCE:

• Bachelor’s Degree with focus on business, finance or statistics or related field required or a minimum of 3+ years of experience in an analytical role with demonstrated research and troubleshooting skills required.
• Advanced knowledge of MS Excel (including complex formulas, pivot tables, and file linkages) and ability to navigate within automated systems.  Proficiency in Outlook and Word required.
• Power BI or other data analytics program experience preferred.

WORKING CONDITIONS:

• Work is normally performed in a typical interior/office/clinical work environment.
• While hours of operation are generally standard, flexibility to work evenings and extended hours may be required.
• Requires periods of sitting, standing, telephone, and computer work. 
• Hearing: adequate to hear clients or patients in person, over the telephone or through telehealth technology.
• Speaking: adequate to speak to clients or patients in person, over the telephone or through telehealth technology.
• Vision: Visual acuity adequate to perform job duties, including reading information from printed sources and computer screens.
• Physical effort required: occasional lifting and carrying items weighing up to 15 pounds, unassisted.
• Possible exposure to blood borne pathogens while performing job duties.
• Frequent bending, reaching, and repetitive hand movements, standing, walking, squatting and sitting, with some lifting, pushing and pulling exerted regularly throughout a regular workday.
• Sufficient dexterity to operate a PC and other office equipment.

This Success Profile is not an exhaustive list of all functions or requirements that you may be required to perform; you may be required to perform other job-related assignments as requested by your supervisor or the company. You must be able to perform the essential functions of the position satisfactorily; however, if requested, reasonable accommodations may be made to enable you to perform the essential functions of this job, absent undue hardship. Signature Health may revise this Success Profile at any time, with or without advanced notice.

All employees of Signature Health are required to comply with the Signature Health Annual Influenza Vaccination Policy. This policy requires employees to obtain an annual flu vaccination. A medical and/or religious exemption may be submitted for review by the Signature Health Review Committee. Exemption requests are not guaranteed to be approved. Signature Health is a drug-free workplace. After receiving a conditional job offer, all applicants must successfully pass a pre-employment drug screen.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c) Administrative