Hospital Bill Audit Coordinator - Houston in Houston, TX at Parallon

Date Posted: 3/15/2018

Job Snapshot

  • Employee Type:
  • Location:
    8101 West Sam Houston Parkway South
    Houston, TX
  • Experience:
    Not Specified
  • Date Posted:

Job Description

Job Summary - Assist in managing and analyzing hospital bill audits by third party payers. Position will serve as liaison between payors, hospitals, and the Shared Service Center (SSC) regarding status of pending, ongoing and finalized audits. Position will evaluate the requests received by the payors to assess if the request is within the terms established by contracts and in accordance with the Hospital Bill Audit by Third Party Payers Policy. Position will notify appropriate responsible parties of reviews and maintain documentation of audit requests, current status, and outcomes of audits in a centralized location. Position will track and trend types of audits received and report findings to Manager. 
Supervisor – Revenue Integrity Director/Revenue Integrity Manager
Supervises – N/A
Duties (included but not limited to): 

• Interacts and coordinates handoffs of audits between responsible SSC departments such as Revenue Integrity for insurance charge audit reviews, HSC for coding or DRG related reviews and Ethics and Compliance and HCA – Regulatory Compliance Support (Regs) for government audits.  Position will communicate with payor representatives related to audit request and coordination of audits to be performed.

• Analyze and approve audit requests received from payors

• Interact with payor to resolve questions or concerns related to coordination of audit request

• Maintain tracking of audits and coordinate obtaining the medical record for auditor to perform on-site audits

• Communicate approved and denied insurance defense audits 

• Maintain statistical data as required

• Practice and adhere to the "Code of Conduct" philosophy and "Mission and Value Statement"

• Other duties as assigned

Job Requirements


• Communication - communicates clearly and concisely, verbally and in writing.  This includes utilizing proper punctuation, correct spelling and the ability to transcribe accurately.

• Customer orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations • Interpersonal skills - able to work effectively with other employees, patients and external parties

• PC skills - demonstrates proficiency in Microsoft Office applications and others as required

• Policies & Procedures - demonstrates knowledge and understanding of organizational policies, procedures and systems

• Basic skills - demonstrates ability to organize, perform and track multiple tasks accurately in short timeframes, have ability to work quickly and accurately in a fast-paced environment while managing multiple demands, ability to work both independently and collaboratively as a team player,  adaptability, analytical and problem solving ability and attention to detail and able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly, spell correctly and transcribe accurately.

• Technical Knowledge  - Knowledge of payer contract requirements preferred but not required
EDUCATION • Associate degree preferred; Equivalent work experience may substitute.
EXPERIENCE • Three years of hospital business office or related financial experience preferred. • Project management and payor contract experience preferred.