Denial And Prepayment Audit Analyst

Overview
This is a remote Corporate position!! Come join our Team!
This candidate must reside in one of these states to be considered: AR, AZ, CA, CO, FL, IL, IN, KY, MI, ND, NE, OH, SC, TN, TX, WA, WI
The Denial & Prepayment Analyst is responsible for the coordination, submission, tracking, and reporting of pre-claim and post payment audits for all lines of business. This position will manage Additional Development Requests (ADR), PreClaim Review (PCR) post payment audits and coordinate all resources involved through the use of clinical and financial applications and tools. They will be responsible for reporting data and statistics related to delayed, retracted, and partial payments or denials. Develops and delivers education to various process participants as part of continuous process improvement.
Responsibilities

• Supports CommonSpirit Health at Home's mission to make the healing presence of God known in our world by improving the health of the people we serve, especially those who are vulnerable, while we advance social justice for all. Our mission aligns and supports with that of our parent health system; supports CommonSpirit Health and CommonSpirit Health at Home's values, strategic goals and high standards of customer service; consistently lives People First Behaviors; and follows the policies and procedures of the organization.
• Adheres to the Corporate Compliance Program, including confidentiality of HIPAA protected health information. Maintains confidentiality of patient information.
  Responsible for coordinating the timely response of all documentation requests and audits through coordination between all involved departments including Compliance, Operations and Revenue Cycle.
• Provides feedback to Operations, Compliance, and Revenue Cycle staff for evaluation of current workflows and processes and determine education solutions to improve denial ratios.
• Provides accurate and timely reporting of Additional Development Requests (ADR), PreClaim Review (PCR) and Post-payment Audits through use of Revenue Cycle applications.
• Evaluates current applications and makes recommendations on functionality and enhancements to current product.
• Serves as member of implementation team, for new applications as well as new releases on existing applications, as a Subject Matter Expert, providing guidance and support to ensure that best practice processes and workflows are taken into account and included in testing plans.
• Assists with new integration setup to ensure smooth transitions in audits and reviews.
• Responsible for planning most efficient processes to achieve them.
• All other duties as assigned.

Qualifications

• High school diploma or equivalent. Associate's degree in Accounting/Finance or related field preferred.
• Three years of office administration or support functional experience in any industry.
• Five years of healthcare, home infusion or ancillary service experience, preferably in Revenue Cycle.
  Experience as a front line user and intermediary to other departments of vendors in one of more of the following applications:
  HCHB, CPR+, McKesson Horizon, or RescueNet/Zoll.
• Working knowledge of Microsoft Office products.
  Strong written and verbal communication skills.
  Excellent time management skills with the ability to self-direct and handle multiple tasks/projects simultaneously.
  Detail oriented and organized.