Signature Health Inc. is a non-profit healthcare agency whose mission is to put good health within reach of all of our community members through comprehensive mental health, medical, and support services essential for optimizing the well-being of mind and body.  Serving patients in Lake, Ashtabula and Cuyahoga counties, we are committed to increasing access to a continuum of care while integrating behavioral and physical health well-being.  If you are passionate about making a difference then we want to talk to you.  We offer employees a dynamic, collaborative work environment along with a comprehensive range of benefit selections to support your total wellness, including several 100% employer paid benefits.

*** After training period is complete, this position will be remote.***

SCOPE OF ROLE

Reporting to the Director, Revenue Cycle the Auditor, Revenue Cycle is responsible for researching denials and/or suspected underpayments from payors, including pre-denial audits and analyzes fee schedules and contracts in order to determine if Signature Health received appropriate reimbursement. Performs recovery efforts on reimbursement discrepancies and follows up until resolution.

HOW YOU’LL SUCCEED ____________________________________________________________________

• Summarize and quantify issues by insurance payer including pertinent information needed to escalate to provider representative.
• Perform claim appeals as necessary to resolve erroneous claim denials as efficiently as possible.
• Review billing system errors to identify denial trends and offer recommendations for resolution.
• Perform analysis on claim underpayments as compared to contractual rates to determine common denominators and themes. Articulate and summarize findings for management.
• Conduct research, analyses, and provide recommendations on routine and non-routine problems.
• Review claim forms to identify any system configuration issues and promptly communicate to management.
• Reviews claim and payer rejections to identify and offer suggestions to mitigate future rejections.
• Perform research on payer denials, payment variances and configuration issues prior to submitting for manager review is essential.
• Conduct a high volumes of transaction and be able to parse data and summarize findings.
• Comply with all agency policies and procedures.
• Maintain all aspects of HIPAA, promoting patient confidentiality and right to privacy.
• May be required to perform telehealth services as determined by Signature Health.
• Adherence and completion of compliance training provided by Signature Health.
• Responsible for and completes all productivity/documentation requirements.
• Participate in all assigned staff meetings and staff development programs.
• Demonstrate appropriate attendance and punctuality in adherence with Signature Health policies.
• Other duties as assigned.

KNOWLEDGE & EXPERIENCE ______________________________________________________________

• Bachelor’s Degree with focus on business, finance or statistics or related field required or a minimum of 3+ years of experience in an analytical role with demonstrated research and troubleshooting skills required.
• Strong attention to detail and a self-starter with the ability to work independently at times.
• Advanced knowledge of MS Excel (including complex formulas, pivot tables, and file linkages) and ability to navigate within automated systems. Proficiency in Outlook and Word required.
• Power BI or other data analytics program experience preferred.

COMPETENCIES __________________________________________________________________________

• Analytical/ Critical thinker
• Applied learning
• Business acumen
• Decision making
• Driving for results
• Innovative thinker
• Planning and Organizing
• Self-starter

WORKING CONDITIONS ___________________________________________________________________

• Work is normally performed in a typical interior/office/clinical work environment.
• While hours of operation are generally standard, flexibility to work evenings and extended hours may be required.
• Requires periods of sitting, standing, telephone, and computer work.
• Hearing: adequate to hear clients or patients in person, over the telephone or through telehealth technology.
• Speaking: adequate to speak to clients or patients in person, over the telephone or through telehealth technology.
• Vision: Visual acuity adequate to perform job duties, including reading information from printed sources and computer screens.
• Physical effort required: occasional lifting and carrying items weighing up to 15 pounds, unassisted.
• Possible exposure to blood borne pathogens while performing job duties.
• Frequent bending, reaching, and repetitive hand movements, standing, walking, squatting and sitting, with some lifting, pushing and pulling exerted regularly throughout a regular workday.
• Sufficient dexterity to operate a PC and other office equipment.

ADDITIONAL INFORMATION ______________________________________________________________

• FLSA Status: Non-Exempt
• Internal Job Code: 1117
• Revenue Status: Non-Revenue Generating
• Last Revision Date: 12/20/2021

This Success Profile is not an exhaustive list of all functions or requirements that you may be required to perform; you may be required to perform other job-related assignments as requested by your supervisor or the company. You must be able to perform the essential functions of the position satisfactorily; however, if requested, reasonable accommodations may be made to enable you to perform the essential functions of this job, absent undue hardship. Signature Health may revise this Success Profile at any time, with or without advanced notice. 

All employees of Signature Health are required to comply with the Signature Health Annual Influenza Vaccination Policy and the Federal COVID-19 Vaccination Mandate.  Both policies require employees to obtain and provide documentation of the respective vaccinations. Medical and/or religious exemptions may be requested, with proper supporting documentation, and will be reviewed by the designated Signature Health Review Committee(s). Exemption requests are not guaranteed to be approved.