Auditor Charge Capture Manager- Patient Financial Services FT

Hunt Regional Healthcare • Greenville, TX

6d

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 requested, concurrent, retrospective, and random audits of patient accounts against medical records; monitors charge variances and audit trends; identifies causes of errors and revenue leakage; and reports monthly results to the Director of Patient Financial Services. The role partners with clinical and ancillary departments, Coding, HIM, Finance, Information Systems, and other stakeholders to address issues, reduce compliance risk, and improve processes and systems. The manager oversees Charge Capture Auditors and Nurse Auditors, provides ongoing education, and serves as the District resource for charge capture and charge description master questions.

The position also develops and maintains policies, procedures, audit tools, and workflows; monitors regulatory and payer changes; and leads staff hiring, training, coaching, scheduling, and performance evaluation. It requires compliance with hospital policies, HIPAA, infection-control expectations, and applicable laws and standards. Due to the nature of hospital services, extended hours may occasionally be necessary.

Requirements

• A 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 comply with HIPAA standards, safety regulations, hospital policies, and required compliance education.

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, and random audits of patient accounts against medical records to assess charge completeness, accuracy, and compliance.
• Monitor and report overcharges, undercharges, late charges, charge lag, and reconciliation variances by department, service line, and charge type.
• Identify departments with inadequate charge documentation or recurring late, missed, or incorrect charges, and partner with department leaders on corrective action plans.
• Ensure charges are supported by clinical documentation and align with coding, revenue, unit, payer, and regulatory requirements.
• Lead root-cause analyses and track corrective actions through resolution.
• Review daily charge rejection and edit work queues, ensure timely resolution, and escalate recurring issues.
• Prepare monthly audit results reports and present results to the Director of Patient Financial Services.
• Quantify and report lost revenue and compliance exposure caused by charge capture errors, and recommend process and system improvements.
• Educate clinical and ancillary departments on charge capture, documentation requirements, and charge description master changes.
• Serve as the District subject matter resource for charge capture questions and collaborate with 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, and evaluate staff; establish performance and productivity expectations.
• Monitor team production, quality, and accuracy, and conduct inter-rater reliability reviews.
• Respond to account inquiries and escalated charge disputes within 24 hours, document actions thoroughly, and involve the PFS Director when needed.
• Manage department resources and workflow responsibly and provide effective customer service to internal and external customers.
• Ensure required compliance training is completed, support identification of high-risk issues, and comply with HIPAA and the organization's Compliance Plan.
• Demonstrate leadership accountability for hand hygiene compliance and follow applicable safety and infection-control practices.
• Perform special duties and projects as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager