Revenue Integrity Charge Auditor

Description

Professional - Nonclinical
Req #: 81104

Summary:
The Revenue Integrity Charge Auditor role promotes the accuracy of charging practices across the organization. This position serves as a liaison between clinical areas and revenue cycle teams to translate billing needs in order to effectively collaborate with practice operations in improving charge capture for their service lines.

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 articulates 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 and assesses revenue impact for charging opportunities.
• Assists in evaluation of 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)

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

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Additional Information

If you have questions about this role, please contact lauren.robare@mainehealth.org