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Claims Auditor

Overview

Assists and supports Hospice to ensure accurate and timely processing of invoices from over 200 vendors that provide a wide range of critical services and products to VNSNY Hospice patients, including SNF Room & Board, hospital inpatient services, consulting physician visits, labs and other ancillary services, non-emergency transportation, medications, Durable Medical Equipment (DME), supplies, etc.  Trains and guides other team members regarding the claims function.  Works under moderate supervision.


Responsibilities
  • Obtains relevant information for processing invoices for reimbursement of Hospice covered services from EMR and billing system, including patient demographics, diagnosis, clinical notes, reimbursement and billing information, and clinical management team.
  • Follows VNSNY procedures for Procurement, Revenue Cycle, and Accounting and utilizes relevant systems for claims and invoice processing and payment.
  • Develops and maintains excellent relationships with finance and billing staff at key providers that invoice VNSNY Hospice for services provided.  Develops and maintains excellent working relationships with staff in VNSNY Clinical Management, Procurement, Accounts Payable, Accounting, FP&A, and Revenue Cycle.
  • Recommends processes and procedures to improve team productivity and quality of output, and to enhance transparency, accountability and efficiency across the function.
  • Trains and mentors less experienced team members, volunteers and/or interns, as needed.
  • Returns phone calls from vendors and providers requesting payment status of invoices and/or whether certain patients were admitted to hospice on certain dates. 
  • Follows up on, tracks, and closes the loop on Part D audit requests.
  • Follows up with vendors and providers, on status of contracts/amendment execution. Coordinates execution of one-time contracts for GIP facilities.
  • Maintains filing system and logs for past invoices, vendor rates, and contract statuses. 
  • Participates in special projects and performs other duties, as required.

Qualifications

Education:  High School Diploma or the equivalent required.  Bachelor’s Degree in Business Administration, in a related field or the equivalent combination of education and experience preferred. 

Experience:  Minimum three years of experience in claims processing, preferably in a health care setting required.  Proficient with personal computers preferably Microsoft Windows, Word and Excel required.  Effective oral and written communication and analytical skills required.  Ability to work in a collaborative team environment required.


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ABOUT US

The Visiting Nurse Service of New York (VNSNY) is the nation's largest not-for-profit home- and community-based health care organization, serving the five boroughs of New York City, and Nassau, Suffolk, and Westchester Countries. For over 125 years, VNSNY has been committed to improving the health and well-being of people through high-quality, cost effective healthcare in the home and community. We offer a wide range of services, programs, and health plans to meet the diverse needs of our patients, members, and clients from before birth to the end of life. Each day, more than 13,000 VNSNY employees - including nurses, rehabilitation therapists, social workers, other allied professionals, and paraprofessionals - deliver compassionate care, unparalleled medical expertise, and 24/7 solutions and resources to more than 44,000 patients and members, helping them to live the best lives possible in their homes and communities.