Clinical Revenue Auditor-CDM Patient Financial Services-Corporate-Full-Time-Days-Hybrid

Responsibilities

• Conduct thorough charge capture/clinical audits to assess the effectiveness of the billing process.
• Identify and rectify missing or incorrect charges, coding errors, and inconsistencies between documentation and billing.
• Perform root cause analysis to understand the underlying issues contributing to revenue leakage and develop corrective action plans.
• Optimize revenue capture by ensuring all billable services are appropriately charged, ultimately maximizing reimbursement for services rendered.
• Ensure adherence to coding guidelines and compliance regulations set by entities like the Centers for Medicare and Medicaid Services (CMS).
• Mitigate the risk of compliance violations, audits, and potential penalties related to billing errors.
• Streamline charge capture processes to improve efficiency and reduce administrative burden.
• Collaborate with clinical, billing, coding, and IT departments to address documentation issues and optimize workflows.
• Leverage charge capture software and analytics tools to identify gaps and areas for improvement in the charge capture process.
• Cooky with payers to ensure timely handling of audit requests, review technical payer denials, determine if an appeal is warranted, and write and track appeal letters.
• Educate clinical teams and other stakeholders on appropriate documentation and charge capture practices to promote adherence to standards and improve overall process efficiency.
• Resourceful in creating or fine-tuning the processes necessary to complete the work along with the ability to organize people and activities.
• Challenge existing norms or courses of action to facilitate fully informed decision-making. Help institute balanced decision-making by identifying risks and opportunities.
• Create and maintain strong working relationships with revenue cycle leaders, key stakeholders, and foster a strong working relationship with key strategic partners.
• Create feedback loops and enhancement pipelines informed by stakeholders and data.
• Ensure compliance with all HIPAA privacy and security standards.

Qualifications

• Bachelor's degree in an applicable healthcare-related profession; Master's degree is preferred.
• 3-5 years of clinical experience is required.
• Strong understanding of medical terminology and patient care.
• Expertise in medical coding systems and healthcare regulations.
• Analytical and problem-solving abilities.
• Excellent communication skills.
• Proficiency with EHR systems and audit software.
• Attention to detail and ethical judgment.
• Demonstrated success in a large not-for-profit/academic health system facility or multi-entity revenue cycle environment.
• Extensive knowledge of medical billing software and electronic medical records.
• Experience working with Epic.
• Knowledge of insurance and governmental programs, regulations, and billing processes (e.g., Medicare, Medicaid, etc.), managed care contracts and coordination of benefits.
• Working knowledge of medical terminology, and medical record coding experience.
• Excellent interpersonal skills and experience working with senior management and other leaders.
• Demonstrated ability to engage in positive, powerful persuasion with individuals or groups with diverse opinions and/ or agendas, leading to outcomes that meet identified goals.
• Excellent verbal and written communication and organizational abilities.
• Accuracy, attentiveness to detail and time management skills.
• The ability to interact effectively with multidisciplinary teams, including physicians and other clinical professionals internally and externally.
• The ability to maintain a high level of positive energy/creativity during periods of elevated work demands.
• The ability to prioritize multiple objectives in a rapidly changing environment and deliver quality outcomes.
• The ability to develop and maintain effective relationships at all levels throughout the organization.
• Licensing and Certification Requirements: Current NYS licensure (RN, OT, PT, SLP, PA, Social Worker, Laboratory Technologist, Radiological Technologist and related professions).
• Certifications such as Certified Professional Medical Auditor (CPMA), Certified Inpatient Coder (CIC), Certified Coding Specialist (CCS), or Certified Healthcare Auditor (CHA) can be beneficial.
• Computer Skills: MS Office Suite (Intermediate).

Pay

$116,718 - $175,000 Annually.

Schedule

Hybrid