Revenue Integrity Charge Auditor

Key Responsibilities

• Functions as a liaison between clinical practices and revenue cycle departments.
• Is a resource for providers, clinical team members, and leaders on charging workflows, charge code questions, and compliant charging.
• Performs ongoing clinical service line reviews of medical records and associated billing to identify potential charging inaccuracies.
• Develops action plans for corrections, quantifies revenue impact, and partners with clinical areas until resolution.
• PARTNERS WITH CLINIC PRACTICES TO IMPLEMENT CHARGE CAPTURE IMPROVEMENTS INCLUDING CHANGES TO SYSTEMS, OPERATIONAL PROCEDURES, OR CHARGING EDUCATION TO MITIGATE REVENUE LEAKAGE.
• Analyzes and identifies deficiencies and inaccuracies in recording charges for services rendered. Designs recommendations for improvements to improve financial outcomes.
• PREPARES CHARGE AUDIT REPORTS THAT ARE CLEAR AND CONCISE; CLEARLY ARTICULATE FINDINGS, REVENUE IMPACT, RECOMMENDATIONS, AND ACTION PLANS.
• PRESENTS FINDINGS TO LEADERS ACROSS CLINICAL PRACTICES AND REVENUE CYCLE.
• RESEARCHES, ANALYZES AND SUPPORTS CHARGE ISSUES RAISED BY THIRD PARTY PAYERS AND / OR AUDIT COMPANIES IN COORDINATION WITH OTHER RESOURCES.
• CONDUCTS CHART AUDITS TO VERIFY COMPLIANT CHARGING IN ACCORDANCE WITH POLICIES AND REGULATIONS.
• COMPILES FINDINGS ANDASSESSES REVENUE IMPACT FOR CHARGING OPPORTUNITIES.
• ASSISTS IN EVALUATING NEW CLINICAL SERVICES FOR PROPER CHARGING AND REIMBURSEMENT CONSIDERATIONS.
• ENSURES NEW CHARGING WORKFLOWS ARE SET UP TO CHARGE SUCCESSFULLY.
• COLLABORATES WITH OTHER DEPARTMENTS ON CHARGING OPPORTUNITIES, COLLABORATING ON ACTION PLANS AND IMPLEMENTING IMPROVEMENTS.

Required Minimum Knowledge, Skills, And Abilities (KSAs)

• Education: Bachelor’s Degree or Associate’s Degree in Healthcare Finance, Health Information or a closely related healthcare field preferred.
• Licenses/Certifications: CCS, CCA, CPC, CPC-H, or CIRCC credential or Nursing (RN) certification preferred.
• Experience: Four years of related work experience such as coding, billing, revenue integrity, documentation improvement, clinical practice, or medical auditing required.
• Additional Skills/Requirements: Knowledge of CPT and HCPCS charging guidelines and principles required. Knowledge of CCI, MUE, LCD/NCD edits and Physician reimbursement methodologies strongly preferred.
• Additional Skills/Requirements: Knowledge of CCI, MUE, LCD/NCD edits and Physician reimbursement methodologies preferred.