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Technical Pre-Bill Auditor - Continuing Care

Shelby, NC, United States
Job ID: 108367
Job Family: Clerical Support
Status: Full Time
Shift: Day
Detailed Shift and Schedule: Monday-Friday 8:00-5:00
Job Type: Regular
Department Name: 43011008041262-Pre-Bill Audit


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 per service line 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 all general payer requirements for compliant billing practices 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 during 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. Bachelor’s or Associates degree in healthcare and/or business preferred. Two years auditing/healthcare reimbursement experience preferred. Strong computer skills, ability to problem solve, analyze and communicate effectively. Work related to healthcare compliance preferred.