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   Current UPMC employees must apply in HR Direct

Auditor I

Description

Purpose:
Do you have experience with behavioral health operations?  Looking for a job with variety?  Look no further than the Auditor I role!  This position is supporting the Western Psychiatric Hospital.  The position will audit and evaluate revenue cycle operations across all departments for Point-of-Service, Patient Access Hospital POS sites and specialty specific accounts receivables.  This role provides support to and interacts with senior leadership, practice plan administration and staff throughout revenue cycle analysis/auditing.

Responsibilities:
  • Maintain Non Audit Plus Service Account. Enter Non Centralized Audits into the department databases. Review and distribute Centralized Audits when necessary. Verify Third Party Audit Payer Responsibility has been met per Third Party Chart Audit Process. Complete necessary documentation, post collection status code, prepare audit bill, UPMC Confidentiality Agreement and UPMC Insurance Audit Settlement Review Sheets.
  • Support Revenue Cycle self-audits to ensure compliance of all revenue cycle protocols, which may include auditing the following: accounts receivables, registration, referrals, scheduling, cash collections, denials and productivity.
  • Ensure timely resolution regarding completed Diagnosis Verification Requests as outlined in the Revenue cycle policies and procedures.
  • Maintain the Identity Theft Log. Review inquirieis, identify root cause i.e. charge positing error, registration error, EMPI error. Work with departments to correct accounts and charges. Complete OCPC Investigation Form when necessary for management review.
  • Complete Insufficient Documentation and CHP HPF Diagnosis Verification Request Queue(s).
  • Support and contribute to UPMC core values and guiding principles and abide by all UPMC departmental policies, procedures and goals in the process of performing all job responsibilities. Incorporates acts of dignity and respect in daily interactions.
  • Assist with Coding Reviews for focusing on modifier, CPT and diagnosis coding issues captured on the Clinical Billing Log. As applicable, work with HIM and Hospital Departments to resolve.
  • Maintain Third Party Auditor Calendar and Contact List making sure all information is current including Medical Record view access.
  • Effectively support assigned non clinical billing holds timely.

Qualifications

  • High School graduate or equivalent and two to four years of health insurance operations, claims processing or general auditing experience required.
  • Two to four years data entry experience.
  • Keyboard dexterity and accuracy.
  • Knowledge of medical terminology, ICD-10 and CPT coding.
  • Knowledge of HMO, POS, PPO, Medicare, SNP, CHIP and Medicaid plans.
  • Detail oriented with excellent organizational, interpersonal and communication skills.
  • Knowledge of MS Office products.

Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life &emdash; because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct