Senior Medicaid Auditor
PeratonConduct cost report, claims, and risk-based audits for Peraton’s healthcare fraud and abuse programs. Analyze findings and support Medicaid audit projects.
Open
Affordable Dentures & Implants is a U.S. dental services organization focused on dentures and dental implants. Its clinic network is supported by affiliated implant providers, dental lab technicians, clinical teams, and corporate business services. The company hires across clinical, laboratory, and corporate roles, with a corporate support center in Research Triangle Park, North Carolina.
Remote Charge Auditor, Payor Relations
Audit healthcare fee schedules, contracted rates, and reimbursement accuracy for U.S. payors. Work with Revenue Cycle Management to identify underpayments and recover missed reimbursements.
Description
- Build and maintain a central repository for every active contract’s fee schedules.
- Keep fee schedule data current with regulatory changes, payer revisions, and bundled payment terms.
- Create change logs and governance procedures for contract amendments, rate escalators, and code updates.
- Compare contracted rate tables with payer agreements, allowable amounts, and internal charge references.
- Identify and document differences among billed charges, contracted rates, and payments across payer categories.
- Coordinate with Revenue Cycle Management to reconcile rate tables and fix configuration issues.
- Investigate underpayments, coding or billing discrepancies, and rate table configuration errors.
- Run fee schedule audits twice a year to find reimbursement leakage.
- Correct rate configuration issues, reduce repeat errors, and recover missed payments.
- Prepare audit findings, trend reports, recommendations, monthly dashboards, and twice-yearly executive reports.
- Hold quarterly business reviews with strategic payors.
- Carry out other duties assigned by the Director of Payor Relations.
Requirements
- A bachelor’s degree in business, finance, healthcare administration, or a related field is required; equivalent experience may substitute.
- At least three years of experience in charge auditing, revenue cycle management, payer contracting, or a related healthcare finance role.
- Experience with contracted rate tables, fee schedules, and payer reimbursement methods.
- Strong analytical and reconciliation abilities, including finding variances and root causes in complex rate data.
- Advanced Excel skills and proficiency with other data analysis or business intelligence tools.
- Strong communication skills and the ability to work effectively with Revenue Cycle Management teams.
- Excellent organization and the ability to establish governance processes and regular reporting schedules.
- Careful attention to detail and the ability to manage multiple priorities and deadlines independently.
- Must be authorized to work for any U.S. employer; visa sponsorship is not available.
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