Revenue Integrity Auditor Full Time Days

Hendricks Regional Health•Danville, IN

About The Position

The Revenue Integrity Auditor identifies billing and coding discrepancies, potential compliance violations, revenue leakage, overpayments, underpayments, documentation deficiencies, and operational control weaknesses. The role develops audit findings, recommends corrective and preventive actions, monitors remediation, and collaborates with Revenue Cycle, Health Information Management (HIM), Coding, Patient Financial Services, Clinical Documentation Integrity (CDI), Compliance, Privacy, and Information Security teams to promote sustainable compliance and financial integrity. The position conducts comprehensive revenue-cycle audits, including end-to-end account reviews and evaluations of coding, clinical documentation, billing, claims, reimbursement, privacy, security, regulatory compliance, and internal controls. It prepares defensible audit workpapers and reports, escalates significant findings, supports investigations and external reviews, and partners with operational leaders on corrective action plans, follow-up testing, education, and process improvements. The role maintains confidentiality, independence, and objectivity throughout the audit process.

Requirements

Bachelor’s degree in Business, Finance, Nursing, or Health Information Management.
Five or more years of revenue-cycle experience within an integrated healthcare system; hospital revenue integrity department experience is preferred.
RHI/RHIT/CCS/BSH license required.
Experience evaluating healthcare regulatory requirements, payer billing policies, and internal controls.
Familiarity with HIPAA privacy and security requirements and handling PHI.
Experience preparing audit reports and appeal letters and identifying root causes.
Ability to conduct comprehensive, objective, and risk-based audits.
Strong knowledge of healthcare revenue-cycle operations, billing practices, and coding guidelines.
Strong analytical, investigative, critical-thinking, and problem-solving skills, including the ability to interpret regulations, payer policies, medical records, financial data, and audit evidence.
Proficiency with electronic health records, billing platforms, spreadsheets, reporting tools, and audit tracking systems.
Excellent written and verbal communication skills, including presenting findings to operational and executive leadership.
Ability to maintain confidentiality, exercise sound judgment, and handle sensitive compliance matters professionally.
Strong organizational skills and ability to manage multiple audits, deadlines, and competing priorities.
Ability to work with associates to promote education, excellence, and job satisfaction; lead, promote long-term employment, and implement new procedures.
Ability to promote teamwork, achieve department goals, and interact appropriately with associates, physicians, and the general public.
Ability to maintain emotional stability and a calm disposition, and demonstrate loyalty, reliability, tact, honesty, and discretion.
Ability to adapt to changes in work schedules and interruptions.

Nice To Haves

Current RN license as a registered nurse.
Hospital inpatient coder with CCS certification.
Experience in a hospital revenue integrity department.

Responsibilities

Conduct routine, focused, retrospective, and risk-based audits across revenue-cycle processes, including registration, eligibility, authorization, charge capture, coding, billing, claims submission, payment posting, and account adjustments.
Perform end-to-end account audits to validate patient encounters, charges, supporting documentation, claim submission, reimbursement, and financial transactions.
Evaluate compliance with internal policies, procedures, payer contracts, reimbursement methodologies, and applicable regulatory requirements.
Identify revenue leakage, missed or duplicate charges, inappropriate write-offs, unsupported adjustments, billing errors, and reimbursement variances.
Assess revenue-cycle controls and recommend improvements to reduce compliance risk and prevent recurring errors.
Develop and maintain audit plans, sampling methodologies, audit tools, workpapers, and supporting documentation.
Audit ICD-10-CM/PCS, CPT, HCPCS Level II, and other applicable coding for accuracy, completeness, specificity, and consistency with medical record documentation.
Evaluate diagnoses, procedures, modifiers, service units, place of service, medical necessity, documentation sufficiency, and other applicable claim elements.
Review compliance with coding guidelines, NCCI edits, medically unlikely edits, payer billing policies, and Medicare, Medicaid, commercial payer, and other applicable billing requirements.
Identify potential upcoding, undercoding, unbundling, duplicate billing, unsupported services, improper reimbursement, missed revenue opportunities, and preventable denials.
Collaborate with coding and CDI teams to clarify documentation deficiencies, validate findings, and support education and corrective action.
Recommend coding corrections, claim adjustments, and other remediation in accordance with organizational policy and applicable law.
Review outpatient, inpatient, and facility claims, as applicable, and evaluate claim edits, denials, rebilling, late charges, and adjustments.
Escalate potential improper payments, suspected fraud, waste, abuse, and significant billing compliance concerns through established channels.
Assess revenue-cycle workflows for compliance with HIPAA Privacy and Security Rules and organizational privacy and security policies.
Evaluate PHI access and handling, minimum-necessary practices where applicable, information use and disclosure, and systems and processes involving sensitive information.
Identify privacy and security risks, inappropriate access, unauthorized disclosures, insecure transmission, and deficiencies in information handling or retention.
Ensure audit materials containing PHI are accessed, stored, transmitted, and retained in accordance with applicable requirements and organizational procedures.
Coordinate suspected privacy or security incidents with Privacy, Information Security, and Compliance teams, and support privacy education for revenue-cycle personnel.
Maintain working knowledge of applicable CMS regulations, Medicare and Medicaid billing requirements, HIPAA, the False Claims Act, payer policies, and other relevant requirements.
Conduct risk assessments and evaluate adherence to compliance policies, coding standards, documentation requirements, and internal controls.
Support compliance investigations, external audit requests, payer audits, governmental reviews, and other regulatory inquiries.
Prepare objective and defensible audit workpapers documenting scope, methodology, evidence, findings, risk levels, and conclusions; promptly escalate significant findings.
Prepare audit reports summarizing findings, root causes, quantifiable financial impact, compliance exposure, and recommended corrective actions.
Partner with operational leaders to develop corrective action plans, assign responsibilities, set target completion dates, and define measurable outcomes.
Conduct follow-up audits and validation testing to confirm corrective actions are implemented and effective.
Monitor recurring errors, audit trends, denial patterns, coding discrepancies, and other key performance indicators.
Develop and deliver targeted education addressing knowledge gaps and recurring compliance issues.
Recommend process improvements, system edits, automated controls, and preventive measures to strengthen revenue integrity.
Maintain appropriate confidentiality, independence, and objectivity throughout the audit process.