RCM Auditor

RCM Auditor Job Description

The RCM Auditor will be responsible for the auditing and reporting of Dental charges and documentation.  An understanding of all areas of the revenue cycle is crucial.  Must be able to work in a fast paced and high volume environment.

Job Responsibilities

• Audit and process dental clean claims for payment by all insurance companies to ensure appropriate and timely charge capture, coding, billing and collections
• Trending & tracking tracking of coding issues identified in all audits
• Targeted education along with general education of providers on how to appropriately code and document dental procedures for billing purposes
• During audit process post adjudication, responsible for sending corrected claim if errors determined in documentation, charge capture and/or coding
• Initiates appeals and ensure all required documentation is submitted in the appeal process for any noted audit issues
• Responsible for defined audits by specialty/provider/practice/payor to ensure accuracy of charge capture, coding and payor adjudication
• Ability to create audit report of process, findings, resolutions and training documents
• Responsible for all payor audit requests
• Responsible for quality work, meeting deadlines, and adherence to Company policies as well as State, Federal and other regulatory bodies.
• Other duties as assigned

Job Qualifications

• Prior experience in general and specialty Dental Office workflows, Revenue Cycle functions to include Insurance verification, fee schedules, claim submission, charging/coding requirements, insurance AR follow up and payment posting process
• Must be knowledgeable of reimbursement/compliance process and procedures with all payors
• Experience with practice management software systems, insurance portals, clearing houses, insurance guidelines, banking reconciliation software, proficient in intermediate PC skills (MS Office/Google Docs—strong excel/google sheet skills). Strong computer literacy, Excellent Math and problem-solving skills.
• Strong interpersonal and organization skills. Ability to work within a team setting and as an individual contributor. Excellent oral and written communication skills
• Detail oriented, organized, process focused, problem solver, proactive, ambitious, customer service focused
• Equivalent to high school diploma or general education degree (GED)
• Minimum 2-4 years of related experience in the dental field