Technical Pre-Bill Auditor Home Health

  • Carolinas Healthcare System
  • Shelby, NC, USA
  • Jan 27, 2018
Full time Healthcare

Job Description

Location Details:  Shelby office
Job Summary
Supports the pre-billing review of claims for all payers to ensure that appropriate, compliant and timely billing occurs for assigned branch locations. Conducts technical audits as prescribed by branch policy & procedure and as directed by leadership. Maintains current knowledge on billing compliance requirements for payors. Provides organizational and branch leadership with timely reports, updates and recommendations for educational opportunities as it relates to audit outcomes. Acts as the liaison with the Branch Leadership and Billing Dept. and participates in regularly established communication/meetings with the branch to ensure timely month-end close.

Essential Functions
  • Performs pre-bill auditing workflow to ensure all branch issues are worked timely and accurately.
  • Runs assigned pre-bill reports and monitors indicators for trends and barriers to meeting agency billing metrics.
  • Stays current in EMR system and identifies system issues, processes and/or opportunities for enhancements to ensure accurate and efficient billing.
  • Stays current with general payer requirements for compliant billing practices - to include Medicare/Episodic Payers, Medicaid, Commercial and Contract- as well as state and federal regulations.
  • Compiles and provides reports from clinical audit outcomes monthly for quarterly review with Operations.
  • Participates in Billing/Operations and/or Compliance meetings as requested.
  • Provides activities/action items to improve team member engagements, supports cultural diversity and an open work environment of positive interdepartmental communication.
Physical Requirements
May carry, stoop, climb or otherwise be physically active in the course of job duties. May have extended periods of sitting and/or computer work. Periodically drives to and from patient homes or to regional meetings in varied weather and traffic conditions.

Education, Experience and Certifications
High School Diploma or GED required. Bachelors or Associates degree in healthcare and/or business preferred. 2-3 years auditing/healthcare reimbursement experience preferred. Strong computer skills, ability to problem solve, analyze and communicate effectively. Work related to healthcare compliance preferred. Current Valid Driver's License required. 
At Carolinas HealthCare System, our patients, communities and teammates are at the center of everything we do. Our commitment to diversity and inclusion allows us to deliver care that is superior in quality and compassion across our network of more than 900 care locations.
As a leading, innovative health system, we promote an environment where differences are valued and integrated into our workforce. Our culture of inclusion and cultural competence allows us to achieve our goals and deliver the best possible experience to patients and the communities we serve.
Posting Notes: Not Applicable
Carolinas HealthCare System is an EOE/AA Employer