Chart Auditor - Glendale

About the role

Supports the Revenue Management Department by auditing medical records and clinical documentation to ensure proper patient status placement, accurate coding, and defensible payer billing. Focuses on clinical denials, observation services, documentation gaps, and payer requirements for authorization and coverage.

Responsibilities

• Conducts concurrent audits of active cases to identify documentation and order issues in real time, preventing downstream denials.
• Applies InterQual or Milliman/MCG criteria to validate patient status decisions and payer medical necessity compliance.
• Reviews medical records to validate patient placement (inpatient vs. observation) against payer criteria and physician orders.
• Audits clinical denials to determine root cause, trends, and opportunities for appeal, and recommends actionable prevention strategies.
• Performs charge audits and account reconciliations to ensure documentation is appropriate, compliant with regulations, and free of denial risk.
• Provides recommendations for charge corrections and technical assistance in staff training.
• Identifies barriers to clean claims and timely payment; tracks and trends denials, escalating systemic issues to the Director/Manager.
• Tracks and trends payer clinical denials, observation hours, and placement errors; prepares reports for Revenue Management leadership.
• Provides feedback to Coding and CDI teams regarding documentation needed for coding accuracy and DRG assignment.
• PARTNERS WITH CASE MANAGEMENT, UTILIZATION MANAGEMENT, MEDICAL OFFICER, AND PHYSICIAN ADVISORS TO ENSURE ACCURATE CLINICAL DOCUMENTATION AND TIMELY STATUS CHANGES.
• Collaborates in payer escalations and appeal preparation by supplying clinical and documentation findings.
• EDUCATES PROVIDERS AND STAFF ON DOCUMENTATION, STATUS ORDER ACCURACY, AND DENIAL PREVENTION STRATEGIES.
• MONITORS CMS, STATE, AND COMMERCIAL PAYER REGULATORY CHANGES IMPACTING CLINICAL DOCUMENTATION, PLACEMENT, AND OBSERVATION REQUIREMENTS; INTEGRATES UPDATES INTO AUDIT PRACTICES.
• Demonstrates reliability, responsiveness, and effective follow-up on matters requiring attention.
• PERFORMS OTHER JOB-RELATED DUTIES AS ASSIGNED.

Requirements

• Education and Work Experience: Associate’s degree in Nursing or related clinical field: Required
• Bachelor's Degree in Nursing (BSN) or Healthcare Administration: Preferred
• Prior experience in utilization review, case management, coding, or clinical auditing: Preferred

Qualifications

• Licenses/Certifications: Current licensed RN in the state of practice (RN), medical provider (MD), or International Medical Graduate with valid credential: Required

Skills

• Strong analytical skills
• Excellent communication and collaboration skills
• Knowledge of healthcare regulations and payer requirements
• Ability to work independently and as part of a team

Benefits

Adventist Health offers a comprehensive benefits program including medical, dental, vision, life insurance, disability, retirement plans, and paid time off.

Pay

The estimated base pay for this position is $62.83 to $86.18. Additional individual compensation may be available for this role through differentials, extra shift incentives, bonuses, etc. Base pay is only a portion of the total rewards package, and a comprehensive benefits program is available for qualifying positions.

Schedule

Full-time, Day Shift