Auditor - Government Claims

Work location: R emote

Work hours: Monday – Friday from 8am to 5pm

Department highlights:

· Great teamwork and collaboration within our group and other departments (internal and external)

· Provide training and education for government contractor audits and appeals process which expands on the revenue cycle

· Professional development opportunities in finance and compliance

Here’s What You Need

· Associate’s degree in Nursing required

· Bachelor’s degree in Nursing required preferred

· 5 years providing patient care in acute hospital setting required

· 2 years auditing in an electronic health record environment required

· 1 year evaluating payor denials and preparing appeals required

· RN upon hire required

· Certified coding specialist (CCS), Certified professional coder (CPC), or Certified inpatient coder (CIC) within 6 months of hire preferred

· Certified Documentation Integrity Practitioner (CDIP), Certified Documentation Expert Inpatient (CDEI) or Certified Clinical Documentation Specialist (CCDS) within 6 months of hire preferred

What You Will Do

· The individual is responsible for analyzing patient medical records and billing information in response to audit requests from the federal government, state governments, Medicare contractors (Traditional Medicare), and Medicaid contractors (Texas Medicaid & Healthcare Partnership), entering and managing data, preparing reports, writing appeals, as well as providing education. The individual works with Revenue Integrity, System Compliance, Health Information Management Services, Finance, CBO, clinical departments, providers, and others as needed. The individual completes assigned work and projects timely. The individual reports directly to the Manager Government Audit Programs.

o Independently evaluate patient medical record and billing information to ascertain case facts and deliver an opinion.

o Using judgement, write appeals and take other actions based on evaluation of patient medical records and billing information of denied claims.

o Using the department’s database, along with Epic, process letters/correspondence, calculate refunds, and adjustments. Additionally, submit claim data/request release of medical records using payor portals or fax.

o Serve as a consultant to the Manager Government Audit Program, System Compliance, physician advisors, THR clinicians, and outside contract payor appeal companies.

o Apply clinical, revenue cycle, and regulatory knowledge to prepare Administrative Law Judge (ALJ) hearing materials and participate in ALJ hearings.

o Analyze trends to initiate feedback/guidance, or education, to clinical departments and providers.

Additional perks of being a Texas Health employee

· Benefits include 401k, PTO, medical, dental, Paid Parental Leave, flex spending, tuition reimbursement, Student Loan Repayment Program as well as several other benefits.

· Delivery of high quality of patient care through nursing education, nursing research and innovations in nursing practice.

· Strong Unit Based Council (UBC).

· A supportive, team environment with outstanding opportunities for growth.

Entity Highlights:

At Texas Health Resources, our mission is “to improve the health of the people in the communities we serve”.

Our award-winning culture is a tribute to our amazing employees. We’re thrilled to be a 2023 FORTUNE Magazine’s “100 Best Companies to Work For®” for the 9th year in a row!

We strive to create an atmosphere of respect, integrity, compassion and excellence for all. We’re committed to diversity in our workforce, and our mission to serve spreads across ethnic, cultural, economic and generational boundaries. Join us and to do your life’s best work here!

Explore our Texas Health careers site for info like Benefits , Job Listings by Category , recent Awards we’ve won and more.

Do you still have questions or concerns? Feel free to email your questions to recruitment@texashealth.org .

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Employment opportunities are only reflective of wholly owned Texas Health Resources entities.

We are an Equal Opportunity Employer and do not discriminate against any employees or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.