"Alerted.org

**Facility:** Corporate Offices

**City** San Diego

Department

Job Status

Regular

Shift

Day

FTE

1

Shift Start Time

Shift End Time

Bachelor's Degree

Hours** **:

Shift Start Time:

Variable

Shift End Time:

Variable

AWS Hours Requirement:

8/40 - 8 Hour Shift

Additional Shift Information:

Weekend Requirements:

As Needed

On-Call Required:

No

Hourly Pay Range (Minimum - Midpoint - Maximum):

$33.090 - $42.700 - $52.310

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position.  The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.

What You Will Do

Performs audits of both government and non-government accounts to expedite and enhance net revenue collection. Also conducts regular quality review audits to ensure Revenue Cycle follows best practices guidelines established by the Revenue Integrity division, with the ultimate goal of reducing accounts receivable.

Required Qualifications

+ 2 Years experience in managed care and fee-for service reimbursement.

+ 2 Years experience with resolving difficult underpayment issues including categorizing inventory into no pay/underpay reason, identifying root cause of underpayments, recognizing trends and clearly and persuasively articulating issues to payor.

+ 2 Years experience working with patient accounts receivable systems.

Preferred Qualifications

+ Bachelor's Degree

Essential Functions

+ Account AuditAudit open and closed balance accounts for denial, underpay, and no pay reasons, and successfully collect additional monies due.Structure audit by payor timeframes, denial/underpay categories, and contract rates with a high propensity for recovery.Trend and identify denial/underpayment issues for training purposes with the goal of preventing and mitigating future denials/underpayments. Document and report out audit findings along with process improvement opportunities and recommendations.Identify issues to be included in future contract negotiations.May be involved in training and/or presentations to staff and upper management.

+ Account ManagementParticipates in and helps facilitate monthly payer calls in conjunction with management and Contract Reimbursement Specialist in reviewing claims processing and rejection issues that delay money collected and AR resolution.Monitor and resolve denied/underpaid accounts, and escalated payer trends/issues to ensure claims are processed and paid per the insurance contract.Other duties as assigned.

+ Quality/Denial PreventionCommunicate directly with Sharp Leadership in conjunction with the Contracts department and/or Revenue Cycle Training Team to report payer trends whether questionable payment/denial practices occur to ensure regulatory requirements governing payer/provider relationships and the terms of the contract.Coordinate issue resolutions with department Managers, other Sharp departments, as appropriate to reduce payer denials/underpayments.Partner with Revenue Cycle Training and Education for user training and education opportunities.Knowledge of all department workflows, procedures and system guidelines for accurate and concise feedback to supervisors and management.

+ ReportsWork on ad-hoc reports to reconcile inventory or identify opportunities for increased revenue collection.Review and trend Denial/Underpayment Management Reports and work with internal report writers on the Revenue Integrity/Analytics teams to produce reports for potential payer trends.

Knowledge, Skills, and Abilities

+ Demonstrated expertise in Microsoft Office applications (Word, Excel and Outlook) and familiarity with Monarch.

+ Aptitude for learning additional software applications such as MS Access.

+ Capable of resolving difficult underpayment issues including categorizing inventory into no pay/underpay reason, identifying root cause of underpayments, recognizing trends and clearly and persuasively articulating issues to payor.

+ Report findings to staff, team leads and upper management.

+ Must possess strong analytical and mathematical skills to resolve accounts receivable inventory.

+ Must be detail oriented and possess a diligent work ethic.

+ Strong communication and excellent interpersonal skills. Team player.

+ Knowledge of government reimbursement methodologies preferred.

+ Knowledge of CPT, ICD-10, and HCPC codes.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class