Pre-Claim Review Audit Specialist
GENERAL PURPOSE:
Responsible for the pre-claim review process including auditing components of medical records but not limited to
performing the billing audit and performing quality assurance audits to ensure accurate billing.
ESSENTIAL FUNCTIONS:
• Accountable for billing audits and clinical quality assurance audits.
• Ensures all functions are completed in compliance with federal, state, and local laws.
• Utilizes EMR or other systems to monitor status of billed and unbilled accounts.
• Completes audit workflow in EMR.
• Provides collaboration with the Billing team and Compliance teams.
• Ensures proper controls are adhered to for accuracy and timeliness of billing.
• Actively contribute to special projects and offers feedback/suggestion to improve process.
• Escalates issues/problems timely to Supervisor.
• Interacts with a variety of personnel in the branch to achieve outcomes.
• Contributes to Empower Services and Revenue Cycle department goals by accomplishing related duties as
required.
• Additional duties as assigned by supervisor and leadership.
Minimum Education & Experience Requirements:
• Associate degree in related field or equivalent work experience.
• Minimum five (5) years healthcare billing experience inclusive of managed care or
• One (1) year in a leadership role providing training, support, and direction.
• Previous supervisory experience a plus.
Knowledge, Skills & Abilities Required:
• In-depth knowledge of healthcare industry billing.
• Detail oriented with strong organization, analytical and problem-solving skills.
• Proficient with software and systems.
• Excellent communication and interpersonal skills.
• Occasional same-day travel for meetings and conferences.
Working Conditions & Physical Effort:
• Work is normally performed in a typical interior/office work environment.
• Ability to work flexible schedule and/or evening hours as needed.
• Sits most of the time; infrequent to occasional walking or standing.
• Ability to sit in front of CPU for long periods of time.
• Ability to travel as needed.
• Physical activity is sedentary and may require occasional lifting or carrying up to 10 lbs.