Medical Records Claims Auditor

Job Description

Job Description

Come join an exciting and innovative company that puts the “care” back in healthcare!

At KabaFusion, our patients come from all walks of life and so do we. We hire GREAT people, period! Our culture celebrates and supports the differences that make us unique. Here, it doesn’t matter what your role is, your hard work and dedication is not only recognized but celebrated. Join us and find out why this is the place to excel and do your best work.

About Us :

What started as a single pharmacy in 2010 has grown into KabaFusion becoming the largest privately held home infusion company in the country. We have a national network of pharmacies and nursing offices strategically placed to service 40+ states. Couple that with over 30 years of combined experience and it’s no wonder why KabaFusion is the industry leader in home infusion.

JOB SUMMARY :

Medical Records Claims Auditor is responsible for evaluating, tracking, auditing, and monitoring processes as they relate to billing to assure accurate claims and compliance.

MAJOR DUTIES AND RESPONSIBILITIES :

• Acts as a liaison between the reimbursement department and various other departments throughout the organization to audit, monitor, track and resolve reimbursement issues.
• Responsible for managing audit request from payers assuring all required documentation is on file and submitted by the deadline for successful results.
• Responsible for tracking and monitoring all Payer request audit for the entire organization and reporting to Director of Reimbursement or other management team members
• Responsible for auditing and managing the Billing Review of new accounts for accurate initial set up of patient accounts with insurance, eligibility, authorization, Start of Care forms, diagnosis and prescriptions
• Responsible for managing, reviewing and responding to all Subpoenas and Medical Record requests, including working with attorney offices or third-party Document Management companies.
• Audits pharmacy online claims for accuracy and correct claim submission for accurate reimbursement
• Assures billing processes are compliant with payer requirement for Government, Commercial Health Plans and Medical Group payers.
• Communicates and addresses reimbursement issues with management for resolution in a timely manner.
• Must be able to prioritize, multi-task, meet goals and deadlines.
• Protects patient health information by following regulations for HIPAA compliance.
• Performs other related duties as directed by Supervisor.

EDUCATION AND / OR EXPERIENCE :

What we offer :

To learn more about KabaFusion, please visit our careers page : https : / / www.kabafusion.com / careers /

Join us and find out why this is the place to excel and do your best work.