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Audit Coordinator 1 - DRG

at EXL

Posted: 10/3/2019
Job Reference #: 6938
Keywords: billing

Job Description

  • Job LocationUS-FL-Jacksonville | US-FL-Jacksonville
    ID
    2019-6938
    Group
    SCIO Healthcare Analytics
    Type
    Contractor / Temps on Agency Payroll
  • Overview

    EXL/SCIO Health Analytics is looking for an Audit Coordinator I - DRG for our Jacksonville, FL location. The position is responsible for the day to day administrative oversight of client workflows, using workflow systems to assess the status of clinical audits and see them through completion. Candidates must possess the skill to prioritize, efficiently and effectively manage tasks.
    General Description: The Audit Coordinator I support all pre and post audit functions by ensuring accuracy of audit invoices, itemized bills, and audit fees. The Audit Coordinator I is responsible for handling calls from providers, auditors, sending letters via fax, email and Fed Ex to providers, and moving the audits through the audit workflow system (SCIOmine).

    Responsibilities

    Workflow Management: Demonstrates ability to effectively/efficiently manage workflows

    * Accurately assesses assigned workflows each day

    * Demonstrates a solid understanding of all sub-statuses and actions needed to complete audits
    * Stays on top of issues, aging until issues are resolved
    * Maintains clean workflows - working with Supervisor to resolve gaps/issues
    * Prepares OM with pertinent details for client updates/calls
    * Ensures confirmed overpayments and record fees are imported each month
    Records Management: Demonstrates ability to effectively manage record requests/receipts
    * Ensures 1st request for records is made timely within 24-48 hours (limitation left over/new selections)
    * Demonstrates ability to effectively monitor record receipt and take action to secure records
    * Demonstrates ability to effectively identify fail points and resolve issue to secure records
    * Demonstrates ability to work with Ops Supervisor to gain assistance if needed from other staff members
    Letters Management: Demonstrates ability to effectively manage letter process and return mail queue.
    *Ensures findings and appeal upheld letters are sent timely within 24-28 hours
    *Demonstrates knowledge/awareness of client approved timelines
    *Able to detect provider sign-offs from appeals including the actions needed to finalize audit
    Repricing: Ensures audit findings are accurately repriced and submitted to client each month
    *Prepares findings files for client re-pricing to confirm overpayments
    * Follows established QC practices to ensure accuracy before submitting
    Invoicing & Audit Fees: Ensures re-priced files are received, invoices are prepared and submitted
    * Ensures invoices are prepared and QC’d for errors before submitting
    * Ensures trackers are updated for future reference and insight
    Call Handling: Handles both incoming and outgoing calls related to program audits
    *Demonstrates ability to assess, address, and resolve issues/inquiries
    * Documents call reason and actions taken in audit system
    * Escalates more difficult issues to Supervisor for handling if no known solution has been provided
    Continuous Improvement: Posses strong knowledge and works with management to improve gaps
    *Identifies challenges, manual work, inefficiencies and brings for solutions to increase overall effectiveness/efficiencies
    *Works with Sup/OM to document SOPs
    *Creates, documents, shares best practices
    * Organizes work folders/SCIONet to the advantage of the team
    * Any other duties necessary/special projections, cross functional support to other internal departments

    Qualifications

    Required:
    • High School Diploma
    • Basic knowledge of provider billing and contracting methodologies
    • Basic knowledge of claims processing
    • 3 years of customer service - preferably in Member/Client Services
    • Working knowledge of MS Excel and Word
    Preferred:
    • Must be computer proficient and possess advances excel skills in excel (v-lookup, pivots, formatting, etc)
    • Must possess excellent organizational skills, time management, priority setting and process improvement
    • Claims processing and customer service skills, a plus

    EEO Statement

    EEO/Minorities/Females/Vets/Disabilities