Revenue Integrity Auditor - Revenue Integrity - FT Days

University of California, Irvine•Irvine, CA

4d•Onsite

About The Position

The incumbent is responsible for performing comprehensive Revenue Cycle audit reviews, which include identifying areas of risk, determination of regulatory and compliance risk, and ongoing audit necessity, as well as determining denial prevention opportunities. This position will focus on evaluating the adequacy and effectiveness of internal and operational controls to ensure that all regulatory and billing compliance guidelines are being met in accordance with hospital and professional billing standards. Audit reviews will include hospital and professional medical record documentation, charge data, coding data, and denial trends, to assess risks and determine potential impacts. The candidate should have extensive knowledge of medical terminology and hold a coding certification, along with experience working with various health plan products such as Medicare, Medi-Cal, HMO, PPO, and Managed Care, as well as private insurance and CMS guidelines. Previous experience in a hospital setting, particularly with split fee billing and a focus on hospital billing, is preferred. This role involves preparing comprehensive audit reports that quantify impacts on both gross and net revenue, identifying opportunities for educational initiatives, and implementing the corrective measures for process improvements.

Requirements

Proficient EXCEL, WORD, PowerPoint skills
Must possess the skill, knowledge and ability essential to the successful performance of assigned duties
Must possess multiple current Coding Certifications (i.e., CPC, COC, or AHIMA equivalent)
Must possess experience reviewing and interpreting CMS, Commercial and Government payer coding and payment requirements.
Must possess a current Coding Certification (CPC, COC, or AHIMA equivalent)
Must demonstrate customer service skills appropriate to the job
Knowledge of health information systems for computer application to medical records
Knowledge of ICD-10-CM & CPT coding conventions to code medical record entries; abstract information from medical records; read medical record notes and reports; set accurate Diagnostic Related Groups
Knowledge of DRG/APC reimbursement
Five years’ experience in hospital and physician billing, charging practices.
Five years’ auditing experience working in acute care hospital and academic institution
Familiarity of audit software packages
Experience in providing both verbal and written feedback or education directly to clinical and/or billing staff regarding coding, charging, documentation, payor authorization, and claim processing requirements.
Excellent written and verbal communication skills in English
Ability to work effectively both as a team player and leader
Ability to use sound judgment and make informed decisions
Ability to use computer to accomplish data input, manipulation, and output
Ability to manage, organize, prioritize, multi-task and adapt to changing priorities
Ability to maintain a work pace appropriate to the workload
Ability to establish and maintain effective working relationships across the Health System, School of Medicine, UCI Research Administration and other UC System campuses
Must be able to provide proof of work authorization

Nice To Haves

Extensive knowledge of medical terminology
Experience working with various health plan products such as Medicare, Medi-Cal, HMO, PPO, and Managed Care, as well as private insurance and CMS guidelines
Previous experience in a hospital setting, particularly with split fee billing and a focus on hospital billing
Knowledge of charge capture workflows and CDM, CRRC
Knowledge of University and Medical Center organizations, policies, procedures and forms
Experience with Epic EMR and billing

Responsibilities

Performing comprehensive Revenue Cycle audit reviews
Identifying areas of risk
Determining regulatory and compliance risk
Determining ongoing audit necessity
Determining denial prevention opportunities
Evaluating the adequacy and effectiveness of internal and operational controls
Ensuring all regulatory and billing compliance guidelines are met
Reviewing hospital and professional medical record documentation, charge data, coding data, and denial trends
Assessing risks and determining potential impacts
Preparing comprehensive audit reports that quantify impacts on both gross and net revenue
Identifying opportunities for educational initiatives
Implementing corrective measures for process improvements