Majestic Care
Corporate Denials and Appeals Audit Specialist
Majestic Care, Westfield, Indiana, United States, 46074
Corporate Denials and Appeals Audit Specialist
Join to apply for the
Corporate Denials and Appeals Audit Specialist
role at
Majestic Care . Position Overview
Through the hearts and minds of our care team members, we provide excellent healthcare to those we serve. With a vision of innovating healthcare by keeping those we serve at the heart of our mission, we provide tools, processes, support resources, data analytics, and insource strategies that drive results. Key Responsibilities
Responsible for the development and implementation of new care team member orientation training programs related to PCC. Creates and delivers intermittent re‑training plans for clinical care team members as needed. Facilitates on‑site support programs and troubleshoots internal user questions/problems as they arise. Maintains oversight by monitoring the PCC environments to ensure data integrity. Extracts data/reports for senior leadership and community leadership upon request. Serves as a liaison for all PCC integrations for new acquisitions. Compliance Auditing and Oversight
Conducts retrospective, concurrent, and prospective audits of medical records across skilled nursing, home health, and hospice settings. Identifies discrepancies, errors, or potential non‑compliance with regulations and internal policies. Leads internal compliance audits, ensuring timely completion and corrective action plans. Tracks audit outcomes and implements monitoring strategies to sustain compliance. Denials Management and Audit Response
Triage pre‑ and post‑payment audit findings and denials, routing them to appropriate teams. Initiates tracking processes and ensures timely filing requirements. Conducts detailed reviews of denied claims to identify reasons for denial. Performs root cause analysis for underlying issues. Prepares and submits appeals with supporting documentation, ensuring payer‑specific deadlines. Develops denial prevention strategies and staff training. Collaborates with departments to improve denial trends. Analyzes denial data to evaluate effectiveness. Maintains accurate records of denial management activities. Supports policy improvements for compliance and efficiency. Stays current with regulatory changes and payer updates. Education
Bachelor's degree required; equivalent experience may be considered. Licenses and Certifications
Certified in Healthcare Compliance (must be obtained within one year of hire). Certificates such as RAC‑CT, RAC‑CTA preferred. Experience
3 years in denials management, ADR/MAC/RAC management of claims. Compliance or healthcare/post‑acute care experience in billing, coding, or revenue cycle. Compliance or healthcare/pre/post payment audits, MDS, PDPM. Claim analysis, appeal writing, payor portal claim management. Knowledge, Skills, and Abilities
Expert knowledge of medical billing, coding, and insurance claims processing (preferably post‑acute). Familiarity with payer portals, appeals, workflows, and EMR systems. Excellent analytical, problem‑solving, communication, and interpersonal skills. Proficiency with healthcare information systems and payer portals. Ability to work independently or as part of a team, manage time, and set priorities. Strong creativity, support confidentiality, and expert O365 expertise. Customer focus, action‑oriented, collaborative across organizational lines. Location and Compensation
Indianapolis, IN | $55,000.00‑$60,000.00
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Join to apply for the
Corporate Denials and Appeals Audit Specialist
role at
Majestic Care . Position Overview
Through the hearts and minds of our care team members, we provide excellent healthcare to those we serve. With a vision of innovating healthcare by keeping those we serve at the heart of our mission, we provide tools, processes, support resources, data analytics, and insource strategies that drive results. Key Responsibilities
Responsible for the development and implementation of new care team member orientation training programs related to PCC. Creates and delivers intermittent re‑training plans for clinical care team members as needed. Facilitates on‑site support programs and troubleshoots internal user questions/problems as they arise. Maintains oversight by monitoring the PCC environments to ensure data integrity. Extracts data/reports for senior leadership and community leadership upon request. Serves as a liaison for all PCC integrations for new acquisitions. Compliance Auditing and Oversight
Conducts retrospective, concurrent, and prospective audits of medical records across skilled nursing, home health, and hospice settings. Identifies discrepancies, errors, or potential non‑compliance with regulations and internal policies. Leads internal compliance audits, ensuring timely completion and corrective action plans. Tracks audit outcomes and implements monitoring strategies to sustain compliance. Denials Management and Audit Response
Triage pre‑ and post‑payment audit findings and denials, routing them to appropriate teams. Initiates tracking processes and ensures timely filing requirements. Conducts detailed reviews of denied claims to identify reasons for denial. Performs root cause analysis for underlying issues. Prepares and submits appeals with supporting documentation, ensuring payer‑specific deadlines. Develops denial prevention strategies and staff training. Collaborates with departments to improve denial trends. Analyzes denial data to evaluate effectiveness. Maintains accurate records of denial management activities. Supports policy improvements for compliance and efficiency. Stays current with regulatory changes and payer updates. Education
Bachelor's degree required; equivalent experience may be considered. Licenses and Certifications
Certified in Healthcare Compliance (must be obtained within one year of hire). Certificates such as RAC‑CT, RAC‑CTA preferred. Experience
3 years in denials management, ADR/MAC/RAC management of claims. Compliance or healthcare/post‑acute care experience in billing, coding, or revenue cycle. Compliance or healthcare/pre/post payment audits, MDS, PDPM. Claim analysis, appeal writing, payor portal claim management. Knowledge, Skills, and Abilities
Expert knowledge of medical billing, coding, and insurance claims processing (preferably post‑acute). Familiarity with payer portals, appeals, workflows, and EMR systems. Excellent analytical, problem‑solving, communication, and interpersonal skills. Proficiency with healthcare information systems and payer portals. Ability to work independently or as part of a team, manage time, and set priorities. Strong creativity, support confidentiality, and expert O365 expertise. Customer focus, action‑oriented, collaborative across organizational lines. Location and Compensation
Indianapolis, IN | $55,000.00‑$60,000.00
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