BronxCare Health System

Nonprofit teaching hospital system in the Bronx

Third Party Audits Coordinator

Internal Audit & ControlsConfirmed live in the last 24 hours

Full-timeBronx, NY, USA$60kIn-person

About the Job

Requirements

Three to five years of collection experience.
Knowledge of Medicare and Medicaid reimbursement processing is preferred.
Experience maintaining patient file information.
Experience with billing information systems.
Experience in a health care environment is preferred.
Strong verbal and written communication skills.
Good analytical skills.
Ability to multitask and willingness to learn new skills.
Ability to deal effectively with multiple information sources.

Responsibilities

Research patient accounts related to audits and activity from third-party payers and internal audits within the required timeframe.
Identify and report root causes for audit recoveries by third-party payers and recommend or participate in corrective actions for BronxCare Health System and MLK.
Contribute to and participate in the assigned department’s performance and quality improvement activities, including data collection and analysis, implementation of and compliance with risk management and claims activities, and participation in Continuous Quality Improvement teams.
Adhere to the health system’s safety and security policies, incident and occurrence reporting requirements, infection control policies and procedures, and patient and customer service standards.
Communicate with third-party payers and internal parties to obtain information needed to complete assignments satisfactorily and on time.
Ensure compliance with billing requirements and timely follow-up for all assigned accounts.
Use information systems to retrieve and verify information and, when appropriate, appeal denied cases through payer web portals.
Obtain medical records for claims denied by payers requesting clinical information, and submit the records to the payer as required.
Review and obtain utilization management status and/or recorded actions.

Desired Qualifications

Knowledge of Medicare and Medicaid reimbursement processing.
Experience in a health care environment.

Overview

Research Patient accounts related with audits and activity from Third Party Payers and internal audits in accordance with therequired timeframe. Identify and report root cause for all audit recoveries by Third Party Payers and recommends and participate in corrective action plan for Bronxcare Health System/MLK.

Responsibilities

Contributes to and participates in the Performance/Quality Improvement activities of the assigned department. Contribution and participation includes data collection, analysis, implementation of and compliance with risk management and claims activities, support of and participation in Continuous Quality Improvement (CQI) teams, consistent adherence to the specific rules and regulations of the Bronxcare Health System (a) Safety and Security Policies, (b) Risk Management: Incident and Occurrence Reporting, (c) Infection Control Policies and Procedures and (d) Patient and Customer Service Identifies and reports root causes for Audit recoveries by Third Party Payers and recommend /participate in corrective action for BCHS and MLK. Communicate with all Third Party Payers and internal parties to obtain required information to finish the assignment satisfactorily and within the required time frame.Responsible to ensure compliance regarding billing and timeliness on followup for all assigned accounts received. Utilizes all information systems toretrieve, verify and or appeal denied cases in payer web portal as appropriate Responsible for obtaining medical records for claims that are denied by the payer requesting clinical information. Obtains and submits medical records to the payer, as required. Reviews and obtains UM status and or action recorded

Qualifications

Three (3) to Five (5) years’ experience of collection in finance knowledge of Medicare and Medicaid reimbursement processing preferred Experience with the maintenance of the patient file information Experience in billing information systems Experience in a Health Care environment preferred Strong communication skills both verbal and writtenGood analytics skills Ability to multi-task and willingness to learn new skills Ability to deal effectively with multiple information sources

Compensation: N/A to 59999.94 (USD)

About the Company

BronxCare Health System

Nonprofit teaching hospital system in the Bronx

BronxCare Health System is a nonprofit teaching hospital network serving the South and Central Bronx in New York City. Its Grand Concourse hospital provides emergency, inpatient and specialty care, while the Fulton Avenue site offers psychiatric and addiction treatment alongside a nursing home. Neighborhood practices provide primary and outpatient care, and the system bills patients and their health plans for clinical services. It trains physicians through accredited residency programs and maintains medical school and clinical affiliations with Mount Sinai. With hospital origins dating to 1890, BronxCare is headquartered at 1650 Grand Concourse in the Bronx.

Company size: 1,001-5,000
Company stage: Not listed
Total funding: Not listed
Headquarters: New York City, New York
Founded: 1890

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