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Hospital Billing Validation Auditor

Company: Hispanic Alliance for Career Enhancement
Location: Lombard
Posted on: September 24, 2022

Job Description:

Hispanic Alliance for Career Enhancement DescriptionHospital Billing Validation Auditor

Change Healthcare is a leading healthcare technology company with a mission to inspire a better healthcare system. We deliver innovative solutions to patients, hospitals, and insurance companies to improve clinical decision making, simplify financial processes, and enable better patient experiences to improve lives and support healthier communities.

Work Location:

  • Fully Remote - U.S.

    Position:

    The Hospital Billing Validation Auditor is responsible for performing accurate clinical audits of inpatient medical records to validate site of service utilizing evidence base criteria. The Hospital Billing Validation Auditor also screens claim data and responds to provider appeals.

    Core Responsibilities:
    • Performs Hospital Billing Validation Audits by applying extensive knowledge of clinical criteria and guidelines accurately and objectively while maintaining productivity targets.
    • Demonstrates ability to appropriately apply clinical criteria to a variety of claims scenarios and effectively utilize audit tools to maximize savings.
    • Works independently to meet or exceed productivity and accuracy goals.
    • Communicates audit findings with excellent grammar and writing skills.
    • Performs appeal reviews and responds to provider disputes for Hospital Billing Validation Audits.
    • Interfaces with Physician advisors and other members of the audit team.
    • Maintains current knowledge of clinical guidelines, reimbursement trends, and client expectations.
    • Demonstrates commitment to Change Healthcare core values.
    • The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

      Requirements:
      • An active and unrestricted RN license
      • 3+ years of clinical nursing experience in the inpatient setting
      • 3+ years of experience in advanced clinical documentation review, or audit experiencewhich may include healthcare compliance, post payment audit, case management, utilization review, and clinical documentation improvement.
      • Advanced experience with national evidence-based screening guidelines
      • Ability to perform in-depth analysis of clinical documentation
      • Experience with InterQual or MCG

        Preferred Qualifications:
        • Professional writing experience
        • Experience writing appeals in a hospital setting is a plus
        • Proficiency with MS Office along with good ability to learn new systems
        • Excellent spoken and written communication skills
        • Excellent analytical skills
        • High level organizational and prioritization skills with the ability to manage multiple, concurrent projects and tasks effectively
        • Ability to be decisive and work well independently

          Working Conditions/Physical Requirements:
          • General office demands

            Travel:
            • No travel required

              Unique Benefits*:
              • Flexible work environments
              • Ready, Set, Grow Career Development Center & access to Change Healthcare University for continuous professional learning & development with more than 5,000 training assets
              • Volunteer days, employee giving and matching gifts programs, community awards and dollars for doers, community partnerships
              • Employee wellbeing programs and generous health plans
              • Educational assistance programs
              • US 401(k) or Group RRSP (Canada) savings plans with matching employer contributions
              • Be sure to ask our Talent Advisors for more information on location specific benefits and paid time off policies
              • Learn more at https://careers.changehealthcare.com
              • *Eligibility for some benefits may be limited or not available for part-time employees, be sure to speak with your Talent Advisor.

                Diversity and Inclusion:
                • At Change Healthcare, we include all. We celebrate diversity and inclusivity, respect each other and value our unique experiences. By being our authentic selves, we bring different perspectives into our work and relationships.
                • Business Resource Groups (BRGs) play a central role in advancing diversity and inclusion at Change Healthcare. They deepen our understanding of different cultures, people, and experiences, and help foster an inclusive workplace. Change offers eight (8) BRGs. Learn more at https://careers.changehealthcare.com/diversity

                  Feeling Inspired? Ready to #MakeAChange? Apply today!

                  #li-remote

                  Diversity and Inclusion:

                  ---At Change Healthcare, we include all. We celebrate diversity and inclusivity, respect each other and value our unique experiences. By being our authentic selves, we bring different perspectives into our work and relationships.
                  ---Business Resource Groups (BRGs) play a central role in advancing diversity and inclusion at Change Healthcare. They deepen our understanding of different cultures, people, and experiences, and help foster an inclusive workplace. Change offers eight (8) BRGs. Learn more at https://careers.changehealthcare.com/diversity

                  Feeling Inspired? Ready to #MakeAChange? Apply today!

                  COVID Vaccination Requirements

                  We remain committed to doing our part to ensure the health, safety, and well-being of our team members and our communities. As such, we require all employees to disclose COVID-19 vaccination status prior to beginning employment and, when job-related and consistent with business necessity, we may require periodic testing for certain roles. Some roles require full COVID-19 vaccination as an essential job function. Change Healthcare adheres to COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance.

                  Equal Opportunity/Affirmative Action Statement

                  Change Healthcare is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status. To read more about employment discrimination protections under federal law, read EEO is the Law at https://www.eeoc.gov/employers/eeo-law-poster and the supplemental information at https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf.

                  If you need a reasonable accommodation to assist with your application for employment, please contact us by sending an email to applyaccommodations@changehealthcare.comwith "Applicant requesting reasonable accommodation" as the subject. Resumes or CVs submitted to this email box will not be accepted.

                  Click here https://www.dol.gov/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdfto view our pay transparency nondiscrimination policy.

                  California (US) Residents: By submitting an application to Change Healthcare for consideration of any employment opportunity, you acknowledge that you have read and understoodChange Healthcare's Privacy Notice to California Job Applicants Regarding the Collection of Personal Information.

                  Change Healthcare maintains a drug free workplace and conducts pre-employment drug-testing, where applicable, in accordance with federal, state and local laws.

                  Job Information
                  • Job ID: 65688440
                  • Workplace Type: On-SitePlease refer to the company's website or job descriptions to learn more about them. Physician RCM, Process Improvement Consultant Clinical Validation Auditor - Remote (anywhere US) Lombard,IL,United States (on-site) Clinical Validation Appeal Auditor - Remote... Lombard,IL,United States (on-site) Hospital Charge Audit Support Chicago,IL,United States (on-site)

Keywords: Hispanic Alliance for Career Enhancement, Lombard , Hospital Billing Validation Auditor, Accounting, Auditing , Lombard, Illinois

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