Chart Auditor - Revenue Cycle Operations - Full Time 8 Hour Days (Exempt) (Non-Union)

Keck Medicine of USC•Los Angeles, CA

1d•Onsite

About The Position

The Chart Auditor is responsible for validating, clearing, and finalizing DNB edits either in the PFS host Patient Accounting system or claims editing system. This role may also involve conducting insurance audits with designated payer auditors per contractual terms and communicating with hospital departments regarding disputed charges, charge capture, or pending supporting documentation.

Requirements

High school or equivalent
Read, write and follow written and verbal instructions.
Working functions of the Medical Record Department.
Good organizational skills and the ability to effectively handle multiple priorities and deadlines.
Operate standard office equipment, for example, scanning equipment, fax machines, multi-line telephone system and copy machines.
Work independently and as a team member.
Maintain confidentiality of sensitive information.
Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)

Nice To Haves

Specialized/technical training Graduate from an accredit program in one of the following areas: LVN, RN, Certified Coding Specialist or Professional Coder.
1 year Experience in medical auditing or HIM coding preferred
Computers and keyboarding skill, PC, Windows, Excel.
Licensed Vocational Nurse - LVN (CA DCA)
Registered Nurse - RN (CA DCA)
Certified Coding Specialist - CCS (AHIMA)
Certified Professional Coder - CPC (AAPC)

Responsibilities

Responsible for interacting with hospital departments including the PFS Business Office, and or insurance/payers on audits, disputed charges and hospital billing and charging problems.
Communicate with hospital department directors on a weekly or as needed basis on outstanding or missing documentation or charging issues.
Completes charge audits or billing edits as necessary in a timely and accurate manner.
Assists with training for new hires or temporary/contract staff.
Complies with USC University Hospital guidelines.
Communicates with , insurance companies or auditing services to resolve complaints or defense audits.
Completes department charge master updates and department requests timely and accurately.
Communicates with hospital departments as needed regarding billing, charging, and documentation problems.
Finds solutions to existing charging problems.
Schedules and conducts high dollar amount defense audits of patient medical records with insurance company representatives to verify documentation to support hospital
Completes charge corrections and coordinates necessary re-bills based on agreed audit results.
Validates and manages bill holds relating to charge reviews held by Risk Management.
Coordinates approvals with Risk Management an d bill release process.
Conduct concurrent or focus audits to validate charge capture audits on randomly selected accounts monthly to identify charging issues which may indicate deficiencies in charge pathways and processes and target specific departmental issues.
Consistently and thoroughly work DNFB and PFS claim edits work lists to ensure timely completion within Keck USC policies and monthly goals.
Assists and supports the Director of Revenue Analysis and Director of A/R Management as assigned.
Performs any other duties and responsibilities as assigned.