Audit Specialist Jobs in North Carolina

DESCRIPTION:

Responsible for providing analytical and operational support for the Iredell Physician Network revenue recovery process. Identify and resolve billing discrepancies, ensure accurate payments, and recover lost revenue. Analyze customer accounts, investigate outstanding balances, and work with clients or internal teams to resolve payment issues. Help management negotiate payment terms, process adjustments, and maintain financial records to improve overall revenue flow. Effectively pinpoint and communicate refund payment variances to and from appropriate payers. Conduct audits, file appeals with insurance payers or clients, and investigate daily error reports and work queues.

• Analyzes trends through detailed account reviews and presents recommendations to management regarding areas requiring process improvement or training.
• Works collaboratively with payers on identified payment discrepancies. Initiates appeals and appropriate correspondences on validated variances.
• Maintains an excellent rapport with internal constituents on revenue recovery processes.
• Keeps abreast of and communicates to leadership proposed regulation which may impact reimbursement process.
• Research complex denials, including Coordination of Benefits (COB) issues.
• Maintain precise records of recovery actions in databases and generate reports on KPIs like recovery rates and denial trends.
• Deliver timely required reports to the management team; initiates and communicates the resolution of issues, such as payor denial trends due to coding and billing errors.
• Responsible for working follow up work queues.
• Responsible for identifying missing payments, overpayments, and analyzing credits on accounts.
• Ability to successfully track and follow up on information requests.
• Work with the IPN Revenue Cycle Team to facilitate information and resolve charge questions.
• Performs other duties as assigned.

REQUIREMENTS

• High School Diploma or GED required.
• Three years of professional billing or coding experience is preferred.
• Knowledge of professional coding is desired.
• Must possess strong critical thinking, analytical, interpersonal, communication and organizational skills necessary to summarize and interpret revenue recovery data from a variety of sources.
• Knowledge of payer reimbursement mechanisms desired.
• Ability to communicate complex technical information effectively in a very dynamic working environment.
• Must be proficient in Microsoft Excel and Word.

ESSENTIAL PHYSICAL REQUIREMENTS:

• Must possess full range of body motion to pass basic FIT test for position to include walking, kneeling, standing, pushing, pulling, bending, stooping, reaching and sitting for extended periods of time.
• Must be able to lift and carry up to 25 pounds.
• Manual dexterity needed for using a calculator and computer keyboard.