Post Payment Audit Specialist, Patient Financial Services
fa-etnv-saasfaprod1.fa.ocs.oraclecloud.com/CX · Minnesota, United States
HealthPartners is looking to hire a Patient Financial Services Post Payment Audit Specialist to join our team! Come join us as a Partner for Good and help us make an impact on the care and experience that our patients and their families receive every day.
Position Summary:
This position collaborates cross-functionally with internal departments, payers, and external vendors to ensure timely and compliant management of audit and denial-related activities, including Recovery Audit Contractor (RAC) audits, Additional Documentation Requests (ADR), Comprehensive Error Rate Testing (CERT), and other regulatory or payer-driven requests. Responsibilities include ensuring all documentation is accurately compiled, submitted, and tracked within established filing deadlines.
The role requires a high level of accuracy, accountability, and timeliness to maintain compliance with organizational policies, payer contracts, and federal and state regulations. The incumbent is responsible for monitoring and managing incoming requests across multiple channels, including mail, electronic portals, and payer communications, ensuring appropriate prioritization and resolution.
This position supports the review of medical records and the development of appeal documentation, working in close partnership with Utilization Management, Coding, Health Information Management, Patient Financial Services, Compliance, Finance, and Audit teams. The role contributes to accurate determinations of level of care, claim status, and reimbursement outcomes.
The work environment is fast-paced and requires effective management of multi-level appeal processes, strong critical thinking, and decisive judgment to support compliant and financially sound outcomes. A strong working knowledge of Medicare guidelines and regulatory requirements is essential. Additionally, this role is responsible for identifying trends, root causes, and process gaps impacting revenue integrity, and collaborates with operational stakeholders to drive corrective actions, education, and process improvement initiatives.
Work Schedule:
Monday through Friday, 7:00 a.m. to 3:30 p.m. or 8:00 a.m. to 4:30 p.m.
Required Qualifications:
Education, Experience or Equivalent Combination:
3–5 years healthcare revenue cycle experience (billing, coding, audits, denials)
Experience with payer audits, appeals, and regulatory requirements (e.g., RAC, ADR, CERT)
Knowledge, Skills, and Abilities:
- Strong knowledge of revenue cycle operations, payer guidelines, and reimbursement methodologies
- Working knowledge of Medicare and Medicaid regulations, including audit and appeal processes
- Ability to interpret clinical documentation, coding, and billing requirements
- Effective written and verbal communication skills, including development of compelling appeal letters
- Ability to manage multiple priorities in a fast-paced, data deadline-driven environment
- Proficiency in electronic medical record systems (e.g., Epic), payer portals, and Microsoft Office applications
- Strong collaboration skills with the ability to influence cross-functional stakeholders to resolve issues
- High attention to detail and commitment to accuracy and compliance
- Identify denial trends, root causes, and systemic issues impacting reimbursement
- Support education and process improvement initiatives to reduce denials and audit risk
- Maintain accurate documentation of all actions taken within applicable systems
- Reviews and understand correspondence received from insurances, including remittance advice, explanation of benefits, and denial letters.
- Makes necessary adjustments and writes off to patient account charges and/or balances
Preferred Qualifications:
Education, Experience or Equivalent Combination:
- Bachelor’s degree in Healthcare Administration, Business, Finance, Nursing, or related field, or equivalent combination of education and relevant experience
- Advanced experience with RAC/ADR/CERT and complex appeals
Licensure/ Registration/ Certification:
- HFMA Certified Revenue Cycle Representative (CRCR)
- Clinical licensure (LPN, or related) preferred for roles involving medical necessity review
Knowledge, Skills, and Abilities:
- Advanced data analysis and reporting skills, including the ability to interpret denial trends, audit findings, and financial impact to support revenue integrity initiatives and leadership decision-making
- Strong proficiency in payer policy interpretation and contract language, with the ability to translate complex regulatory and reimbursement requirements into effective appeal strategies and operational
Benefits:
HealthPartners offers a competitive benefits package (for eligible positions) that includes medical insurance, dental insurance, a retirement program, time away from work, insurance options, tuition reimbursement, an employee assistance program, and much more!