[Remote] PFS Auditor, Remote

Note: The job is a remote job and is open to candidates in USA. Ambry Genetics is a company focused on patient financial services, and they are seeking a PFS Auditor to review and appeal claims related to clinical validation and coding denials. The role involves conducting audits, ensuring compliance with billing practices, and collaborating with other departments to improve processes.

Responsibilities

• Conducts SOX reviews by assessing internal controls and auditing billing processes
• Conducts pre and post billing reviews to ensure quality standards are met prior to billing. Completes assignments in a manner that meets the quality assurance goal of 100% accuracy
• Monitors the results of claims audit policies and procedures and reports findings to appropriate leadership
• Utilizes Medicare and Contractor guidelines for coverage determinations. Utilizes extensive knowledge of medical terminology, ICD-10-CM, HCPCS Level II to conduct audits
• Participate in pre- & post-review meetings, providing support and recommendations for issues presented. Ensure past review recommendations are implemented in current review process
• Provides a broad-based knowledge in billing and collections, strong knowledge of industry practice and business principles to ensure department is compliant with all billing practices
• Works in partnership with other departments for education on patient billing policies and process improvements
• Other duties as assigned

Skills

• Knowledge of CPT codes, medical terminology, insurance plans, ICD 10 codes
• Utilizes Medicare and Contractor guidelines for coverage determinations. Utilizes extensive knowledge of medical terminology, ICD-10-CM, HCPCS Level II to conduct audits
• Must have ability to adapt to a fast paced, dynamic environment
• CPC or CPMA preferred
• Associates degree preferred

Benefits

• Short-Term Incentive Plan with the target at 5% of your annual earnings; terms and conditions apply.

Company Overview