Chart Auditor (Portland)

Adventist Health•Portland, OR

About The Position

In a bustling cosmopolitan area surrounded by nature, Adventist Health Portland has been one of the area’s leading healthcare providers since the 1800s. In partnership with OHSU, we are comprised of a 302-bed hospital, 11 medical offices, home care services, comprehensive cancer care and a vast scope of award-winning services located throughout East Portland and the surrounding areas. There are many outdoor adventures readily available, including carving the snow at North America’s only year-round ski resort, hiking along the Columbia River Gorge or taking a day trip to the unmatched beauty of the Oregon coast. Job Summary: Supports the Revenue Management Department by auditing medical records and clinical documentation to ensure proper patient status placement, accurate coding, and defensible payer billing. Focuses on clinical denials, observation services, documentation gaps, and payer requirements for authorization and coverage. Collaborates with Case Management, Utilization Management, Coding, Medical Officer, and Physician Advisors to reduce clinical denials, improve documentation quality, and ensure compliance with regulatory and payer standards. Provides analytic reports and feedback to identify systemic trends and educational opportunities.

Requirements

Associate’s degree in Nursing or related clinical field: Required
RN or MD (or international medical graduate with valid credential): Required

Nice To Haves

Associate’s degree in nursing: Preferred
Bachelor’s degree in Nursing: Preferred
Bachelor’s degree in Nursing or Healthcare Administration: Preferred
Prior experience in utilization review, case management, coding, or clinical auditing: Preferred

Responsibilities

Conducts concurrent audits of active cases to identify documentation and order issues in real time, preventing downstream denials.
Applies InterQual or Milliman/MCG criteria to validate patient status decisions and payer medical necessity compliance.
Reviews medical records to validate patient placement (inpatient vs. observation) against payer criteria and physician orders.
Audits clinical denials to determine root cause, trends, and opportunities for appeal, and recommends actionable prevention strategies.
Performs charge audits and account reconciliations to ensure documentation is appropriate, compliant with regulations, and free of denial risk. Provides recommendations for charge corrections and technical assistance in staff training.
Identifies barriers to clean claims and timely payment; tracks and trends denials, escalating systemic issues to the Director/Manager.
Tracks and trends payer clinical denials, observation hours, and placement errors; prepares reports for Revenue Management leadership.
Provides feedback to Coding and CDI teams regarding documentation needed for coding accuracy and DRG assignment.
Partners with Case Management, Utilization Management, Medical Officer, and Physician Advisors to ensure accurate clinical documentation and timely status changes.
Collaborates in payer escalations and appeal preparation by supplying clinical and documentation findings.
Educates providers and staff on documentation, status order accuracy, and denial prevention strategies.
Monitors CMS, state, and commercial payer regulatory changes impacting clinical documentation, placement, and observation requirements; integrates updates into audit practices.
Demonstrates reliability, responsiveness, and effective follow-up on matters requiring attention.
Performs other job-related duties as assigned.