This position serves as a liaison and resource between Boston Children's Hospital and third party payers for the purpose of verifying and validating hospital, physician and ancillary charges on paid and prepaid claims against clinical documentation maintained in a patient's medical record.
This Audit Coordinator will be responsible to:
Maintain and coordinate third-party charge and prepayment audits with insurance companies, auditing firms, and internal departments.
Log and maintain scheduled audits and all data pertaining to each audit in Cobius Audit Software.
Provide copies of itemized bills, UB claims, and pharmacy profiles to auditors and upload into Cobius Audit Software.
Review and accept or deny audits based on account reimbursement and contract guidelines from insurance companies and their representatives.
Provide related clinical documentation maintained in Power Chart or other clinical systems.
Work closely with CHB departments to obtain supporting documentation for related services provided.
Respond and/or rebut charge and prepayment audits as necessary.
Record all audit adjustments timely.
Document all actions taken on account with clear and concise account notes.
Manage daily assignments and workloads using standardized protocols and work queues.
Prepare reports as required.
Demonstrate a thorough understanding of the billing instructions, policies, procedures, and requirements of third-party billing with regards to inpatient and outpatient services.
Inform department manager of internal or external issues and trends affecting accurate billing. Contribute to problem-solving efforts to resolve receivable issues through feedback, information, and research.
Provide positive and effective customer service that supports departmental and hospital operations.
Participate in process improvement opportunities.
Responsible for updating Cobius Audit Software with all audits and manage all the reports in the system
Assist with UAE/International department to add supporting documentation when requested to the IPP Portal.
Work in accordance with required State and Federal regulations and hospital policies.
To qualify, you must have:
High school diploma is required and a minimum of 1 year of direct related experience
Excellent verbal and written English language skills
Able to communicate professionally and effectively
Strong problem solving and analytical skills
Basic computer knowledge
Well organized and able to prioritize work and excellent attention to detail
Good understanding of medical terminology and codes, preferred
Familiarity with 3rd party payer requirements.
Able to work with a team that works in a fast paced environment
Remote work if you live in MA, RI, NH or ME
Skilled at evaluating analytics and understanding content within the data. BCH offers competitive compensation and unmatched benefits, including a flexible schedule, affordable health, vision and dental insurance, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition Reimbursement, and discounted rates on T-passes. Discover your best.
Boston Children's Hospital is a 395-bed comprehensive center for pediatric health care. As one of the largest pediatric medical centers in the United States, Children's offers a complete range of health care services for children from birth through 21 years of age.