Pre-Claim Review Audit Specialist - EMPOWER

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.