Revenue Integrity Charge Auditor-Remote

Shared Business Services - United States

Job Summary

Responsible for ensuring that all appropriate billing charges are being captured, documented, charged and reimbursed for the assigned department in accordance with policies and procedures, and applicable regulatory standards and requirements. Plans, conducts and evaluates reviews and audits of clinical documentation and billing practices for conformity with applicable regulatory requirements.

Essential Functions

Determines and conducts reviews and/or audits to identify potential charges and billing issues including lost revenue opportunities proactively identifying opportunities to strengthen charge capture processes and enhance regulatory compliance
Prepares reports based on audit findings, providing summary documents and presentations to leadership and impacted departments
Coordinates with facility clinical departments, BSC operational areas, and other impacted departments to ensure audit findings are appropriately addressed, through the development of actions plans and implementation of best practice charging methods
Identifies, researches, and analyze billing errors, discrepancies, and omissions; coordinating with appropriate team members to incorporate correct processes into EHR systems
Compiles and analyzes all approve audit requests received from payors and third-party vendors
Maintains knowledge base and materials for BSC and facility departments in relation to all payor updates, billings and coding standards to include but not limited to CPT, ICD-10, and APC
Provides training and education to clinical/charging staff and management on appropriate documentation and charge capture processes

Minimum Education

BA/BS Degree in education, business administration, healthcare administration or finance preferred

Minimum Required Work Experience

Three (3) years healthcare revenue cycle; with experience in electronic health records and coding

RHIT/RHIA, CCS, CMA, CPC-P, CPCP-H or other equivalent certification required. LPN/LVN or RN may be substituted in lieu of certification.

Required Skills

Advanced proficiency in Microsoft Office applications
Requires critical thinking skills, problem solving, decisive judgment, ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action.

Minimum Required Work Experience

Three (3) years healthcare revenue cycle; with experience in electronic health records and coding required. Revenue Integrity, Chargemaster, auditing experience preferred.

Knowledgeable in health care compliance programs, healthcare reimbursement standards, third party payor guidelines, insurance verification systems, patient liability estimation tools, and electronic health records systems.

Job Business Office
Primary Location Pennsylvania-Johnstown
Other Locations Georgia, Alabama, Louisiana, South Carolina, Kentucky, Tennessee, Michigan, Indiana, North Carolina

Schedule Full-time
Shift Day Job