Chargemaster Auditor, Revenue Cycle, Full Time. First Shift

At UC Health, we're proud to have the best and brightest teams and clinicians collaborating toward our common purpose: to advance healing and reduce suffering. As the region's adult academic health system, we strive for innovation and provide world-class care for our community and patients from all over the world. Join our team to develop your skills, grow your career, build relationships with peers and patients, and help us be a source of hope for our friends and neighbors.

Qualifications

• High School diploma – Minimum Required (Healthcare focus)
• Bachelor’s Degree – Preferred
• Professional Medical Auditor (CPMA) or equivalent certification – Preferred
• Minimum Required: 1 - 2 years equivalent experience
• Preferred: 3 - 5 years equivalent experience

Responsibilities

• Perform Audits:
  • Performs detailed and focused charge audits on inpatient and outpatient accounts, including defense, prebill, and CPT/charge code line item audits
  • Evaluates the appropriateness of services and procedures charged based on supporting documentation
  • Evaluates the appropriateness of ICD, CPT, and HCPCS codes
  • Reviews audit results with management and staff, incorporating feedback from internal/external customers as appropriate
  • Tracks, reports, and communicates audit findings, including reimbursement and compliance information
  • Enters and maintains charge audit results data
• Present Findings & Recommendations:
  • Assists in developing constructive recommendations and education for clinical departments based on audit findings
• Partner with Internal Audit:
  • Performs charge-related audits as part of the annual audit program
• Charge Capture Outreach Education & Training:
  • Works with revenue-producing clinical department managers to develop and provide educational sessions for staff on issues identified through audits
  • Responds to clinical department questions and reviews cases to assist with correct charge capture processes and procedures
  • Attends educational sessions, training, and task force meetings as directed
• Charge Edits:
  • Reduces Accounts Receivable on Unbilled Accounts by resolving charge-related errors
  • Researches and resolves a variety of issues relating to charge capture
  • Edits claims (DNB, Claim Edits, and Stop Bills) within scope of authority to meet timely billing requirements
  • Analyzes and corrects patient claims/accounts to ensure clean claim submissions and maintain work queues
• Process Improvement:
  • Identifies areas for improvement to minimize errors and/or denials
  • Shares and presents findings and recommendations for improved workflow
• Other Duties:
  • Provides occasional backup for other auditors or CDM team members

Location: Cincinnati, OH, United States