100% Remote opportunity.
This is a temporary full-time positionending July 2021 with the potential to become permanent.
The Contract Modeling Auditor will review, research, and check accuracy of all loaded contracts, single case agreements, and service setup within the Aveanna EMRs This includes pricing, coding, products, etc. for all contract payers including commercial, Medicare, and Medicaid. This position will report to the Director of Billing.
Essential Job Functions
Understand payor contracts, state/national guidelines, and contract management system as appropriate.
Obtain accurate understanding of the contract language, billing requirements, and fee schedules.
Work with Contracting to resolve issues, clarify contract terms, etc.
Audit contract terms that are loaded by the SIMs team for accuracy and expected revenue. Includes but not limited to service codes/products, standard rates, expected rates, rounding, and effective dates.
Recognize and recommend changes as needed based on the contract and system configuration.
Work with Compliance to resolve issues, clarify Medicare and Medicaid billing requirements, etc.
Maintain hard copy contract file.
Provide excellent customer service.
Ensures that procedures and assigned duties comply with SOX regulations.
Other duties as assigned by supervisor.
Evaluates data, reports, feedback, observations and other information in determining priorities.
Uses prior knowledge and industry specific, historical experiences in resolving problems.
Relies on instructions and pre-established guidelines to perform the functions of the job.
Uses professional communication and conflict resolution techniques as required.
References and reflects upon the Company mission, values, and strategic imperatives in completing and/or assigning all work.
A certain degree of creativity and latitude is required.
Conducts all assignments as a professional and role model with a sense of urgency.
High school diploma
Ability to work independently with little supervision.
General knowledge of Healthcare contract modeling.
Extensive knowledge of Medicare, Medicaid, and Payer specific guidelines is preferred.
Must be multi-tasked oriented.
Microsoft Office Suite experience (Word, Excel, PowerPoint, Teams)
PreferencesCollege degree preferred
Cisco Security Certification is a plus
Must be able to adhere to confidentiality standards and professional boundaries at all times
Attention to detail
Ability to remain calm and professional in stressful situations
Strong commitment to excellence
Quick-thinking and astute decision-making skills
Effective problem-solving and conflict resolution
Excellent organization and communication skills
Must be able to speak, write, read and understand English
Occasional lifting, carrying, pushing and pulling of 25 pounds
Prolonged walking, sitting, standing, bending, kneeling, reaching, twisting
Must be able to sit and climb stairs
Must have visual and hearing acuity
Must have strong sense of smell and touch
Performs duties in an office environment during agency operating hours
Must be able to function in a wide variety of environments which may involve exposure to allergens and other various conditions
Other DutiesPlease 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.
Headhunters and recruitment agencies may not submit resumes/CVs through this website or directly to managers. Aveanna does not accept unsolicited headhunter and agency resumes, and will not pay fees to any third-party agency or company that does not have a signed agreement with Aveanna.
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