Auditor (Medical)

Auditor (Medical)

Healthcare Industry – Melville, NY

Job Description

Growing Healthcare Receivable Management Company seeking a detail-oriented full-time Auditor/Analyst with a medical background in medical/hospital billing and coding to Analyze and follow up on patient accounts.  Experience with Health Insurances is preferred.

Summary of Responsibilities:

• Follow up and analysis on hospital patient accounts, including follow up with third party payers

Responsibilities:

• Review medical records to determine if all charged items and services are documented and respond to denials from third party payers by providing documentation
•  Review itemized/detailed bills to determine if charges for all documented items/services are valid and respond to denials from third-party payers
• Review/Analyze Physician/Outpatient accounts to determine issue causing denial or delay of payment;
• Review denials related to ICD-10 and  CPT code denials
• Review medical necessity denials due to lack  of documentation/insufficient coding.
• Submit written claim/payment disputes as necessary;
• Prepare and submit appeals for authorization denials/administrative denials as necessary;
• Follow up on status for Outpatient/Physician claims and/or denials;
• Communicate with other departments in order to have accounts reviewed and obtain additional information needed to dispute claims issues as needed;