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CHC Nursing Facility Audit Investigator I (remote)

Description


UPMC Health Plan is hiring CHC Nursing Facilities Audit Investigators to assist and complete audits for the CHC Nursing Facility audit department. In this position, you will assist and complete audits for the CHC Nursing Facility audit department. You will also reconcile audit documents provided by the Nursing Facility in accordance with the UPMC NF Audit Department process.

Responsibilities:

 

  • Assist the Department Manager in the activities of the UPMC CHC Nursing Facility Audit Department for accurate and timely dissemination of NF billing practices.
  • Perform all functions of the UPMC CHC NF Audit Department as directed by the Department Manager or more senior level Investigators which may include planning, scheduling, and executing NF audits.
  • Effectively prioritize and complete tasks related to accurate and timely processing of NF audits according to Dept Guidelines.
  • Develop working relationship with CHC Claims/Support Area to obtain NF reports for audit purposes.
  • Maintain accurate records for reporting to NF Audit Dept Manager.
  • Identify and report NF trends to NF Dept Manager for potential NF education.
  • Participate in Training/Education sessions as needed.
  • Remain current with all government regulations and procedures affecting Nursing Facilities billing practices.
  • Performs in accordance with system-wide competencies/behaviors.
  • Anticipates and acts to maintain a safe work environment. Incorporates safety/risk management standards into daily work practices.
  • Ability to communicate with third-party Providers.
  • Performs other duties as assigned.

 

Qualifications

  • Bachelor's Degree or equivalent education and/or work experience.
  • Knowledge of third-party reimbursements, federal and state regulations, Medicare, and Medicaid requirements is required.
  • At least 2 years of experience in this field.
  • Minimum of two (2) years of experience in long-term care billing or audit preferred. Working knowledge of computer operations including Microsoft Office Products (Excel, Word and Outlook).
  • Strong written and verbal communication skills. Organized, methodical and attention to detail.


Licensure, Certifications, and Clearances:

  • Act 34

  • UPMC is an Equal Opportunity Employer/Disability/Veteran

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