Southwoods Health · 1 month ago
Audit and Appeals Specialist
Boardman, OH
Full-time
Onsite
Mid LevelSouthwoods Health is hiring an Audit and Appeals Specialist to work in their business office. The Specialist will be responsible for managing third-party payer audits and appeals, ensuring accurate documentation and timely responses to overturn denials through detailed analysis.
Health CareHospital
Responsibilities
Record incoming third-party payer audits and organize reviews and appeals to ensure they are performed in a timely manner
Assist with compiling documentation and write timely, compelling appeals to third-party payers to overturn denials
Perform ongoing analysis to determine the root cause of denials and make recommendations for workflow or operational changes
Research and develop a solid understanding of payer requirements, including but not limited to filing limits, reimbursement policies, claim processing logic, and authorization requirements
Properly direct any problems with accounts where additional intervention is needed for resolution and timely corrections to accounts receivable balances
Perform other revenue cycle duties as assigned
Qualification
Required
Demonstrated hands-on experience with payer audits, payment integrity reviews, and formal appeals across commercial, Medicare, and Medicaid payers
Strong understanding of CMS regulations, OIG guidance, and payer-specific audit and appeal requirements
Familiarity with RAC, MAC, Medicare Advantage, and commercial payer audit processes
Effective communication skills and the ability to problem solve
Maintain professional demeanor at all times, demonstrating strong ethical and moral principles
Comprehensive knowledge of operational aspects of the revenue cycle and measures to take in resolving claim issues
Company
Southwoods Health
The Surgical Hospital at Southwoods patients have trusted for their healthcare needs.
Founded in 1996
501-1000 employees
Funding
Current Stage
Late StageTotal Funding
$1.51M2023-10-06Series Unknown· $0.58M
2021-12-15Series Unknown· $0.93M
Recent News
2023-10-12
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