Payment Auditor

Summary/Objective Under limited supervision, the Payment Auditor is responsible for identifying insurance claims paid incorrectly to maximize revenue recovery. The Payment Auditor acts as a vital cross-functional liaison, partnering with payor contracting teams and external payors to recover revenue, monitor recovery metrics, and provide subject matter expertise on complex reimbursement issues. Essential Job Functions Audit and identify patient accounts paid incorrectly based on specific, active contracts with insurance payors. Consistently review, prioritize, and clear designated payment variance work queues within the Epic electronic health record system. Work from regular, high-volume financial reporting to actively target and isolate system-wide or account-level underpayments. Log, track, and thoroughly document all underpayment discrepancies and audit findings within Epic. Partner with payor contracting teams and external payors to recover identified underpayments. Track monitor and regularly communicate total collected revenue metrics to management. Act as an internal resource to answer complex questions relating to reimbursement issues, payment terms, and contract structures for diverse patient populations. Extract, manipulate, and analyze large, complex datasets to identify systemic contract non-compliance or systemic payor underpayments. The duties listed above are representative of the role, and an individual may be responsible for performing all, or a specific subset, of these functions. Additionally, an individual may be required to perform other related tasks and responsibilities as applicable or assigned to meet operational and client needs. Key Success Indicators/Attributes Must be adept at multi-tasking and prioritizing a variety of tasks, often changing assignments on short notice in a fast-paced environment. Strong analytical, critical thinking, and problem-solving skills to successfully manage individual KRAs and meet production metrics. Excellent verbal, listening, and written communication skills to build trust, maintain credibility, and remain composed during stressful situations. Perform data entry with accuracy while safeguarding corporate and client assets, proactively reporting any security compromises. Skill in operating a computer and learning multiple software or hardware systems concurrently within an average workday. Supervisory Responsibility No Work Environment This job operates in a remote home office environment. This role routinely uses standard office equipment such as computers and phones. Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; and talk or hear. The employee must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, peripheral vision, depth perception and the ability to adjust focus. Position Type/Expected Hours of Work This is a full-time position. Days and hours of work are generally Monday through Friday, 8:00 a.m. to 5 p.m. This position occasionally requires long hours and weekend work. Travel Minimal travel required; up to 5% Required Education and Experience High school diploma, or equivalent. Minimum 3 years of healthcare experience or a comparable combination of education and experience. Ability to manipulate and analyze large amounts of data. Strong foundational knowledge of medical billing practices and medical terminology. Preferred Education and Experience Direct experience handling payment variances or contract modeling within Epic. Equivalent experience in managed care, health care finance, or healthcare information technology. Additional Eligibility Qualifications N/A Security Access Requirements In addition to the specific security access required by the employee’s client engagement, the employee will have access to the Omega set forth in the “Omega Field Employee” profile. Equal Employment Opportunity: Omega Healthcare is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, gender, age, sexual orientation, gender identity or expression, marital status, mental or physical disability, protected veteran status, and genetic information, or any other basis protected by applicable law. Omega Healthcare also prohibits harassment of applicants or employees based on any of these protected categories. Omega Healthcare makes reasonable accommodations when needed for applicants and candidates with disabilities or religious observances. If reasonable accommodation is needed to participate in the job application, interview, or any other part of the hiring process, please contact Human Resources at [email protected]. Other Duties Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice. Employee may perform other duties as assigned. High school diploma, or equivalent. Minimum 3 years of healthcare experience or a comparable combination of education and experience. Ability to manipulate and analyze large amounts of data. Strong foundational knowledge of medical billing practices and medical terminology. Preferred Education and Experience Direct experience handling payment variances or contract modeling within Epic. Equivalent experience in managed care, health care finance, or healthcare information technology.