Change Healthcare Hospital Billing Validation Auditor in Helena, Montana
Hospital Billing Validation Auditor
Change Healthcare is a leading healthcare technology company with a mission to inspire a better healthcare system. We deliver innovative solutions to patients, hospitals, and insurance companies to improve clinical decision making, simplify financial processes, and enable better patient experiences to improve lives and support healthier communities.
Fully Remote - U.S.
The Hospital Billing Validation Auditor is responsible for performing accurate clinical audits of inpatient medical records to validate site of service utilizing evidence base criteria. The Hospital Billing Validation Auditor also screens claim data and responds to provider appeals. Core Responsibilities:
Performs Hospital Billing Validation Audits by applying extensive knowledge of clinical criteria and guidelines accurately and objectively while maintaining productivity targets.
Demonstrates ability to appropriately apply clinical criteria to a variety of claims scenarios and effectively utilize audit tools to maximize savings.
Works independently to meet or exceed productivity and accuracy goals.
Communicates audit findings with excellent grammar and writing skills.
Performs appeal reviews and responds to provider disputes for Hospital Billing Validation Audits.
Interfaces with Physician advisors and other members of the audit team.
Maintains current knowledge of clinical guidelines, reimbursement trends, and client expectations.
Demonstrates commitment to Change Healthcare core values.
The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.
An active and unrestricted RN license
3+ years of clinical nursing experience in the inpatient setting
3+ years of experience in advanced clinical documentation review, or audit experience which may include healthcare compliance, post payment audit, case management, utilization review, and clinical documentation improvement.
Advanced experience with national evidence-based screening guidelines
Ability to perform in-depth analysis of clinical documentation
Experience with InterQual or MCG
Professional writing experience
Experience writing appeals in a hospital setting is a plus
Proficiency with MS Office along with good ability to learn new systems
Excellent spoken and written communication skills
Excellent analytical skills
High level organizational and prioritization skills with the ability to manage multiple, concurrent projects and tasks effectively
Ability to be decisive and work well independently
Working Conditions/Physical Requirements:
General office demands
No travel required
Flexible work environments
Ready, Set, Grow Career Development Center & access to Change Healthcare University for continuous professional learning & development with more than 5,000 training assets
Volunteer days, employee giving and matching gifts programs, community awards and dollars for doers, community partnerships
Employee wellbeing programs and generous health plans
Educational assistance programs
US 401(k) or Group RRSP (Canada) savings plans with matching employer contributions
Be sure to ask our Talent Advisors for more information on location specific benefits and paid time off policies
Learn more at https://careers.changehealthcare.com
*Eligibility for some benefits may be limited or not available for part-time employees, be sure to speak with your Talent Advisor.
Diversity and Inclusion:
At Change Healthcare, we include all. We celebrate diversity and inclusivity, respect each other and value our unique experiences. By being our authentic selves, we bring different perspectives into our work and relationships.
Business Resource Groups (BRGs) play a central role in advancing diversity and inclusion at Change Healthcare. They deepen our understanding of different cultures, people, and experiences, and help foster an inclusive workplace. Change offers eight (8) BRGs. Learn more at https://careers.changehealthcare.com/diversity
Feeling Inspired? Ready to #MakeAChange? Apply today!
Diversity and Inclusion:
•At Change Healthcare, we include all. We celebrate diversity and inclusivity, respect each other and value our unique experiences. By being our authentic selves, we bring different perspectives into our work and relationships.•Business Resource Groups (BRGs) play a central role in advancing diversity and inclusion at Change Healthcare. They deepen our understanding of different cultures, people, and experiences, and help foster an inclusive workplace. Change offers eight (8) BRGs. Learn more at https://careers.changehealthcare.com/diversity Feeling Inspired? Ready to #MakeAChange? Apply today!
COVID Vaccination Requirements
We remain committed to doing our part to ensure the health, safety, and well-being of our team members and our communities. As such, we require all employees to disclose COVID-19 vaccination status prior to beginning employment and, when j ob-related and consistent with business necessity , we may require periodic testing for certain roles. Some roles require full COVID-19 vaccination as an essential job function. Change Healthcare adheres to COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance.
Equal Opportunity/Affirmative Action Statement
Change Healthcare is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status. To read more about employment discrimination protections under federal law, read EEO is the Law at https://www.eeoc.gov/employers/eeo-law-poster and the supplemental information at https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf.
If you need a reasonable accommodation to assist with your application for employment, please contact us by sending an email to email@example.com with "Applicant requesting reasonable accommodation" as the subject. Resumes or CVs submitted to this email box will not be accepted.
Click here https://www.dol.gov/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf to view our pay transparency nondiscrimination policy.
California (US) Residents: By submitting an application to Change Healthcare for consideration of any employment opportunity, you acknowledge that you have read and understood Change Healthcare’s Privacy Notice to California Job Applicants Regarding the Collection of Personal Information (https://www.changehealthcare.com/privacy-notice/privacy-notice-to-california-job-applicants) .
Change Healthcare maintains a drug free workplace and conducts pre-employment drug-testing, where applicable, in accordance with federal, state and local laws.
Change Healthcare is an equal opportunity employer. All qualified applicant will reveive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status.