Revenue Cycle Audit Coordinator

Audit Coordination

Capture all incoming medical record requests from insurance companies, government agencies, third-party auditors, and regulatory entities, attorneys. Prioritize requests based on payer deadlines and financial impact. Maintain an audit tracking log documenting receipt, submission, due dates, and final determination.

Medical Record Retrieval

• Retrieve complete and accurate medical records from the electronic health record.
• Review documentation to ensure all required components are included prior to submission.
• Cook with Health Information Management (HIM), Case Management, Coding, Patient Financial Services, and clinical departments when additional documentation is needed.
• Verify documentation is legible, complete, and meets payer requirements.

Record Submission

• Submit medical records through payer portals, secure fax, electronic upload, certified mail, or other approved methods.
• Ensure submissions meet payer-specific formatting and documentation requirements.
• Maintain confirmation of receipt and submission documentation.

Audit Follow-Up

• Monitor audit status through completion.
• Track outstanding requests and follow up with payers as needed.
• Notify Revenue Cycle leadership of high-dollar audits, trends, or potential reimbursement risks.
• Cook with Denial Management on adverse determinations requiring appeal.

Reporting & Analytics

• Maintain audit statistics, including:
  • Number of requests received
  • Number completed
  • Turnaround times
  • Dollars at risk
  • Audit outcomes
• Identify payer trends related to pre-payment reviews and post-payment audits.
• Aid in preparing reports for Revenue Cycle leadership.

Compliance

• Maintain compliance with HIPAA and organizational privacy policies.
• Ensure medical records are released only to authorized entities.
• Maintain confidentiality of protected health information.
• Follow CMS, Medicare, Medicaid, and commercial payer audit requirements.

Other Duties

• Perform additional duties and special projects as assigned to support Revenue Cycle operations and organizational goals.
• Support the Medical Center’s Mission/Vision/Philosophy positively.