Chargemaster Revenue Auditor PRN

Job Summary

The Chargemaster Revenue Auditor is responsible for ensuring accurate and compliant coding, charging, and documentation processes that directly affect revenue integrity. This role coordinates with clinical departments, the business office, and insurance verification teams to optimize reimbursement, reduce claim denials, and support appeals.

Essential Functions

• Ensures proper coding and charging of imaging and interventional procedures in compliance with payer and regulatory guidelines
• Reviews physician orders against insurance pre-authorizations; resolves discrepancies with provider offices
• Participates in annual updates to CPT/HCPCS codes and ensures integrity of the chargemaster
• Works with department leadership to implement process improvements that reduce denials and support revenue growth
• Coincides with departmental leadership on documentation and support for claim denials and appeals
• Aids with departmental quality assurance reporting and supports clinical QA initiatives
• Investigates and resolves patient charge or file discrepancies
• Compiles data and prepares routine and ad hoc statistical and financial reports for departmental leadership
• Acts as liaison between Imaging Services and Business Office on revenue integrity matters

Knowledge/Skills/Abilities/Expectations

• Knowledge of payer policies, reimbursement methodologies, and hospital billing practices
• Ability to detect and correct billing/coding errors independently
• Strong communication and interpersonal skills for collaboration with staff, physicians, and external contacts
• Proficiency in medical terminology and office software including word processing and billing systems
• Excellent organizational and time management skills
• Demonstrates professionalism and maintains strict confidentiality in all activities
• Ability to work independently in a high-volume, detail-oriented environment

Qualifications

• Education: High school diploma or equivalent required
• Specialized training in CPT/HCPCS coding systems and reimbursement practices required
• Licenses/Certifications: Certification in medical coding or billing preferred (e.g., CPC, CCS); continuing education in CPT/HCPCS coding practices required
• Experience: Minimum of two (2) years’ experience with CPT/HCPCS coding for diagnostic imaging or related services; strong understanding of medical necessity documentation, coding compliance, and revenue cycle operations