Location: Idlewild Ave, Tampa, FL
Reporting to: Dir, Claims Audit
Department: Ops-Provider Operations
Position is responsible for overseeing, giving direction/feedback to their Audit team members with regard to completion and performance of their daily tasks and responsibilities. Acts as a subject matter expert for all audit questions/issues.
- Acts as a Subject Matter Expert (SME).
- Reviews all second level rebuttals.
- Reviews Peer Review scores with Auditors and recommends process improvement.
- Works with Manager to maintain appropriate work balance in the department in order to maximize productivity.
- Assists in developing of long-range goals for claims audit specialist and Sr. claims audit specialists.
- Accept the responsibilities of the manager of Claims Audit in his/her absence and ensure that the department runs smoothly & without disruption to the daily routine.
- Researches and recommends solutions for escalated issues. Presents proposed solutions in a clear and concise manner.
- Responsible for performance management responsibilities for direct reports.
- Assists with developing and maintaining departmental policies and procedures including desk top procedures.
- Assists with developing training materials for the department and facilitate training as needed.
- Analyzes errors and performs root cause analysis in order to determine appropriate classification.
- Presnts audit findings and / or mediates issues external to the department.
- Assists with identification and communication of process improvement opportunities across operation areas based on quality reviews.
- Performs additional duties as assigned.
- Required A High School or GED
- Preferred A Bachelor's Degree in a related field
- Required 5 years of experience in a healthcare organization
- Required 5 years of experience in understanding and interpreting contracts as related to claims processing and system configuration
- Advanced Knowledge of healthcare delivery
- Intermediate Demonstrated organizational skills
- Intermediate Demonstrated time management and priority setting skills
- Intermediate Ability to drive multiple projects
- Intermediate Ability to work independently
- Advanced Demonstrated analytical skills
- Advanced Demonstrated problem solving skills
- Advanced Demonstrated interpersonal/verbal communication skills
- Intermediate Knowledge of medical terminology and/or experience with CPT and ICD-9 coding
- Intermediate Ability to work as part of a team
- Intermediate Ability to work in a fast paced environment with changing priorities
- Intermediate Ability to multi-task
- Intermediate Other Decision making ability that requires the use of considerable judgment in the analysis of processes and problems/errors resulting from those processes
- Intermediate Other Knowledge of HCPCS Coding
- Advanced Other Ability to facilitate small group meetings
- Advanced Other Ability to remain calm under pressure
- Intermediate Other Ability to concentrate for extended periods on specific tasks
Licenses and Certifications:
A license in one of the following is required:
- Preferred Other Certified Medical Coder
- Required Intermediate Microsoft Excel
- Required Intermediate Microsoft Outlook
- Required Intermediate Microsoft Word
- Required Intermediate Microsoft PowerPoint
- Required Intermediate Other Demonstrated technical expertise in performing quality reviews along with analysis of results
- Preferred Intermediate Other Knowledge of Perot / Peradigm system