Auditor Charge Capture Manager- Patient Financial Services FT

Hunt Regional Healthcare•Greenville, TX

About The Position

The Auditor Charge Capture Manager leads the charge capture auditing program to ensure charges are complete, accurate, timely, and compliant with regulatory and payer requirements. The manager directs concurrent, retrospective, requested, and random audits of patient accounts against medical records and reports results monthly to the Director of Patient Financial Services. The role partners with clinical and ancillary departments, Coding, HIM, Finance, and Information Systems to identify root causes of charge errors, reduce revenue leakage, and mitigate compliance risk. It oversees Charge Capture Auditors and Nurse Auditors, provides ongoing education to departments, and serves as the District resource for charge capture and charge description master questions. The position also monitors audit performance and charge-related work queues, reports trends and financial or compliance exposure, develops corrective actions and process improvements, maintains policies and audit tools, and hires, trains, coaches, schedules, and evaluates staff. It is accountable for compliance, patient confidentiality, customer service, infection-control leadership, and responsible management of department resources.

Requirements

Degree in Healthcare Administration, Business, Finance, Nursing, or a related field; an equivalent combination of education and experience may be considered.
At least two years of experience in healthcare revenue cycle, charge capture, coding, or billing compliance auditing.
Thorough knowledge of hospital charge capture, CPT/HCPCS coding, revenue codes, modifiers, UB-04 billing, and outpatient reimbursement methodologies.
Working knowledge of CMS regulations, NCCI edits, medical necessity, and compliance requirements.
Strong analytical skills, including the ability to interpret data, identify trends, and present findings to leadership.
Proficiency with hospital information systems, Microsoft Excel, and reporting tools.
Ability to interpret and generate written correspondence using proper grammar, spelling, and composition.
Excellent verbal and written communication skills.
Ability to lead, coach, and develop staff; manage competing priorities; and work independently with minimal supervision.
Prior experience involving public contact.
Ability to meet the position's hospital compliance, confidentiality, safety, and professional conduct expectations.

Nice To Haves

Active Texas Registered Nurse license.
Professional certification such as CPC, CCS, CHRI, CRCR, or equivalent.
Experience with Cerner or a comparable hospital information system and work queue management.

Responsibilities

Direct concurrent, retrospective, requested, and random charge capture audits of patient accounts against medical records.
Monitor and report overcharges, undercharges, late charges, charge lag, and charge reconciliation variances by department, service line, and charge type.
Identify inadequate charge documentation and patterns of late, missed, or incorrect charges, and partner with department leaders on corrective action plans.
Verify charges are supported by clinical documentation and comply with CPT/HCPCS coding, revenue codes, modifiers, units, payer rules, and regulatory requirements.
Lead root cause analyses and track corrective actions through resolution.
Review daily charge rejection and charge edit work queues, ensure timely resolution, and escalate recurring issues.
Prepare and present a monthly audit results report to the Director of Patient Financial Services.
Quantify and report lost revenue and compliance exposure from charge capture errors, and recommend process and system improvements.
Provide ongoing education to clinical and ancillary departments on charge capture, documentation requirements, and charge description master changes.
Serve as the District's charge capture subject matter resource for clinical departments, Coding, HIM, Finance, IT, and Managed Care.
Collaborate with Information Systems to test, validate, and monitor charge-related system builds, interfaces, and upgrades.
Monitor regulatory and payer changes and update audit tools, policies, and education accordingly.
Develop and maintain department policies, procedures, audit tools, and workflows.
Hire, train, coach, schedule, evaluate, and set performance and productivity expectations for staff.
Monitor team production, quality, and accuracy, and conduct inter-rater reliability reviews.
Respond to account inquiries and escalated charge disputes within 24 hours, resolving issues in a timely and amicable manner and involving the PFS Director when needed.
Ensure accurate and thorough documentation of comments and actions on patient accounts.
Manage department resources and workflow responsibly and promote excellent customer service.
Promote organizational values and compliance, complete required compliance education, assist with identifying high-risk issues, and comply with HIPAA standards.
Demonstrate leadership accountability for hand hygiene compliance by monitoring performance data and following through on corrective actions.
Perform assigned special duties and projects.