Audit Specialist

About the Role

Responsible for maintaining the process and timely response to billing compliance audits conducted by Medicare, Medicaid, and commercial health plans. Audit Coordinators analyze health plan reimbursement policies for coverage and documentation requirements, review patient file documentation for completeness and accuracy, procure and retrieve documentation, and initiate and respond to inquiries from AdaptHealth Account Executives, operations teams, and physicians regarding additional supporting medical necessity documentation.

Responsibilities

• Develop and maintain working knowledge of current HME products and services offered by the company.
• Maintain and review all required documentation for insurance coverage and reimbursement per insurance guidelines and company policy.
• Log and report all received audit inquiries: Prepayment audits/development letters; post payment requests for documentation; overpayment refund requests; medical necessity documentation and CERT audits; all other audit activity as assigned.
• Retrieve all documentation including, but not limited to proof of delivery, written orders, Certificates of Medical Necessity, clinical test results and/or studies, letters of medical necessity, medical record notes, signature attestations, Advanced Beneficiary Notices, etc.
• Contact AdaptHealth Account Executives, operations teams, and physicians to obtain additional supporting medical necessity documents.
• Review all documentation to be submitted for audit purposes for completeness and accuracy.
• Report to supervisor any apparent issues and coordinate submission of all required documentation.
• Complete all required fields and notes in proprietary audit application.
• Scan and upload audit request, submission, correspondence, findings, and results.
• Assist with tracking and reporting of audit findings and results.
• Assist with implementation of performance improvement program as it relates to billing and coding performance.
• Maintain confidentiality of all audit projects and information.

Requirements

• High School Diploma or equivalent.
• One (1) year work related experience in health care administrative, financial, or insurance customer services, claims, billing, call center or management regardless of industry.
• Senior level requires two (2) years of work-related experience and one (1) year of exact job experience.
• Exact job experience is considered any of the above tasks in a Medicare certified HME, Diabetic, Pharmacy, or home medical supplies environment that routinely bills insurance.

Skills

• Knowledge of Medicare, Medicaid, and commercial health plan reimbursement methodologies and documentation requirements.
• Excellent verbal and written communication skills.
• Well organized, detail oriented and possess strong problem-solving and critical thinking skills.
• Ability to prioritize tasks, manage multiple projects and work independently.
• Ability to adapt and be flexible in a rapidly changing environment, be patient, accountable, proactive, take initiative and work effectively on a team.
• Ability to read and interpret documents such as Medicare, Medicaid and commercial health plan policy articles and procedure manuals.
• Ability to prepare routine reports and correspondence.
• Ability to speak effectively before groups of employees of the organization.
• Ability to calculate figures and amounts such as discounts, interest, proportions, and percentages. Ability to apply concepts of basic statistics.
• Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.
• Strong proficiency in Microsoft Office: Excel, Word, Outlook.