Revenue Integrity Audit Coordinator

Altru Health System • Grand Forks, ND

95d • $17 - $25

About The Position

The Revenue Integrity Audit Coordinator is responsible for reviewing, analyzing, and appealing denials related to DRG (Diagnostic Related Group) validation denials. This role involves validating the coding and clinical accuracy, ensuring proper documentation, and collaborating with other departments to address payer concerns. Key responsibilities include timely investigation of DRG downgrades, submitting appeals, coordinating follow-up actions, and ensuring compliance with regulatory standards. The specialist also plays a critical role in preventing future downgrades by identifying trends and providing feedback to improve coding and clinical documentation practices.

Requirements

• A minimum of 1 year Related Experience
• Proficiency in reading, writing, and speaking English to ensure effective communication in the workplace and with patients, families, and team members.

Nice To Haves

• Associates - Related Field
• Bachelors - Related Field

Responsibilities

• Review DRG validation denials from payers by analyzing denial reasons, conducting thorough medical record and coding reviews, and determining the appropriateness of initial coding and clinical documentation.
• Prepare, document, and submit comprehensive appeals for DRG denials with clinical evidence, coding guidelines, and regulatory support while monitoring appeal deadlines to ensure timely compliance with payer requirements.
• Collaborate with coding staff to identify and resolve complex DRG denial cases, improve coding accuracy, and enhance overall departmental performance in denial prevention.
• Track and analyze DRG denial trends to identify common denial causes, provide feedback to coding and CDI teams for prevention strategies, and implement corrective actions to reduce future occurrences.
• Maintain accurate denial appeal records in designated software including status tracking, timelines, and outcomes while contributing to revenue protection through successful appeal outcomes and reduced financial impact of DRG downgrades.
• Analyze denial patterns to identify root causes, collaborate on preventive strategies, and proactively address internal process discrepancies to prevent future denials.
• Conduct regular clinical documentation audits to ensure compliance with coding, billing practices, and payer requirements while maintaining proper documentation collection to avoid potential denials.
• Develop and implement process improvements for denial prevention including enhanced workflows, improved interdepartmental communication, and technology solutions.
• Provide regular reports and feedback to leadership and relevant departments on denial prevention efforts, identifying areas requiring attention and tracking improvement outcomes.
• Perform other duties as assigned or needed to meet the needs of the department/organization.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Hospitals
• Education Level: Associate degree