What are the responsibilities and job description for the Audit and Appeals Specialist position at Southwoods Health?
Location: Southwoods Executive Centre (Business Office), Boardman, Ohio
Employment Type: Full-Time (40 hours per week)
Southwoods Health is hiring an Audit and Appeals Specialist to work in our business office. The Specialist is responsible for recording, organizing, and compiling third-party payer audits and corresponding appeals to ensure accurate documentation and timely responses. This role also serves as a key resource for second-level appeals, working to overturn denials through detailed analysis of audit findings, medical records, coding, and payer policies.
Essential Duties:
For more information and to apply, please visit our website: www.southwoodshealth.com
Employment Type: Full-Time (40 hours per week)
Southwoods Health is hiring an Audit and Appeals Specialist to work in our business office. The Specialist is responsible for recording, organizing, and compiling third-party payer audits and corresponding appeals to ensure accurate documentation and timely responses. This role also serves as a key resource for second-level appeals, working to overturn denials through detailed analysis of audit findings, medical records, coding, and payer policies.
Essential Duties:
- Record incoming third-party payer audits and organize reviews and appeals to ensure they are performed in a timely manner.
- Assist with compiling documentation and write timely, compelling appeals to third-party payers to overturn denials.
- Perform ongoing analysis to determine the root cause of denials and make recommendations for workflow or operational changes.
- Research and develop a solid understanding of payer requirements, including but not limited to filing limits, reimbursement policies, claim processing logic, and authorization requirements.
- Properly direct any problems with accounts where additional intervention is needed for resolution and timely corrections to accounts receivable balances.
- Perform other revenue cycle duties as assigned.
- Demonstrated hands-on experience with payer audits, payment integrity reviews, and formal appeals across commercial, Medicare, and Medicaid payers.
- Strong understanding of CMS regulations, OIG guidance, and payer-specific audit and appeal requirements.
- Familiarity with RAC, MAC, Medicare Advantage, and commercial payer audit processes
- Effective communication skills and the ability to problem solve.
- Maintain professional demeanor at all times, demonstrating strong ethical and moral principles.
- Comprehensive knowledge of operational aspects of the revenue cycle and measures to take in resolving claim issues.
- Hours: Full-time, 40 hours per week.
- Availability: No evenings or weekends required.
For more information and to apply, please visit our website: www.southwoodshealth.com