Job Summary
The role involves the creation, management, testing, and optimization of audit concepts related to payment integrity for durable medical equipment, home health, and home infusion claims. This position ensures compliance with coding standards, payer policies, and regulatory guidelines.
Responsibilities
- Develop and maintain audit concepts for payment integrity.
- Conduct testing and optimization to enhance audit processes.
- Align audit concepts with coding standards and payer policies.
- Provide guidance on policy and training related to audit operations.
- Collaborate with clients to ensure compliance and quality assurance.
- Utilize analytics to drive improvements in workflow efficiency.
Qualifications
- A bachelor’s degree or equivalent experience is required.
- Minimum of five years of experience in post-acute services, or three years specifically in post-acute claims or recovery auditing.
- A nationally recognized nursing or coding credential is necessary.
- In-depth understanding of post-acute coding and payment policies for Medicare and Medicaid.
- Expertise in audit concept development and data analysis.
- Strong communication skills and experience in managing workflows effectively.
