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Lead Recovery Auditor

ACCA Consulting

This is a Contract position in Toronto, ON posted January 22, 2023.

If you’re ready to be part of our legacy of hope and innovation, we encourage you to take the first step and explore our current job openings.

Your best is waiting to be discovered.

– 08 Hour (United States of America) This is a Stanford Health Care
– University Healthcare Alliance job.

A Brief Overview The Lead Recovery Auditor performs routine and complex audits on processed claims to identify recovery opportunities.

Will audit focused recovery reports on potential overpayment issues.

Research and document audit findings and determine origin and appropriate resolution.

Summarize findings and recommendations in reports for Accounting/Recovery Supervisor.

Locations Stanford Health Care
– University Healthcare Alliance What you will do Auditing & Analysis Lead auditing data results from recovery queries on identified overpayment issues each month; complete related reports.

Audit data results each quarter to establish baseline recovery issues.

Research potential CAP deductions and report findings to Finance Dept.

Complete special recovery projects as assigned, including auditing claims and reporting findings.

Send recovery requests/letters on partial overpayments.

Lead in review and processing of denials and appeals.

Documentation Process and document stop loss and third party liability claims; complete related reports.

Create, develop and maintain Recovery Management Reports.

All other duties as assigned including department-specific functions and responsibilities (1, 2): Performs other duties as assigned and participates in organization projects as assigned.

Adheres to safety, P4P’s (if applicable), HIPAA and compliance policies.

On an annual basis review the UHC Pay and Chase report to determine if HCPC codes need to be added/deleted based on the revised UHC Pay and Chase agreement.

Review UHC Pay and Chase monthly report.

Review Stop Loss monthly report.

Lead disputes for Stop Loss and UHC Pay and Chase denials.

Education Qualifications High School Diploma or GED Required Some college education Preferred Experience Qualifications Strong working experience with ICD-9, CPT and HCPC coding systems.

Required 5 years to 7 years claims processing and auditing experience in an IPA or HMO related setting Required Required Knowledge, Skills and Abilities Thorough knowledge of medical terminology, enrollment and membership activities and claim processing procedures/systems with initiative to resolve issues Strong knowledge of Microsoft Word and Excel applications.

Excellent written and oral communication skills, with experience in writing business letters Ability to exercise good judgment and handle a fast paced environment and to assess and coordinate departmental work flows effectively.

Ability to audit all types of medical claims and interpret authorizations, contracts and physician reimbursement methodologies.

Exhibit a thorough understanding of industry standard claims processing guidelines.

These principles apply to ALL employees: SHC Commitment to Providing an Exceptional Patient & Family Experience Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families.

Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other.

C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions.

Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.

You will do this by executing against our three experience pillars, from the patient and family’s perspective: Know Me: Anticipate my needs and status to deliver effective care Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health Coordinate for Me: Own the complexity of my care through coordination Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment.

Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above.

People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply.

Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.

Base Pay Scale: Generally starting at $31.20
– $39.77 per hour The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training.

This pay scale is not a promise of a particular wage.