Revenue Integrity Auditor

HHC•Indianapolis, IN

7d•Onsite

About The Position

The Revenue Integrity Auditor is responsible for pre- and post-payment auditing of medical records and associated clinical documentation to ensure proper charge capture, billing in accordance with standard billing policies and reimbursement principles. This position is responsible for assisting Revenue Cycle Services, Health Information Management (HIM), Coding, Clinical Documentation Improvement (CDI), and other departments with resolution of billing issues and/or denials requiring clinical expertise, participating in external audit requests, and special projects as needed. This position also serves as an audit outcome educator with clinical staff in clinic and department settings.

Requirements

Medical Technician, LPN or RN, with current state licensure OR certified R.H.I.A., R.H.I.T., CCS, CCS-P, CPC, CPC-H, CCA, OR Associate's degree required; bachelor's degree preferred
Experience with Health Information Management (HIM), Facility/Physician Billing, Charge Description Master (CDM), Denials Management, Charge Integrity, Financial Analysis
Three years of experience in a hospital or physician setting with extensive Revenue Cycle knowledge
Two years of hospital audit experience with a concentration in High Balance and Cost Outlier and/or facility-based clinic audits
Extensive knowledge of various coding systems, including but not limited to ICD-10-CM, CPT-4, HCPCS, as well as medical terminology, anatomy and physiology, diagnostic and therapeutic tests
Knowledge of DRG and APC classifications and reimbursement methodologies
Extensive knowledge of billing processes and payer requirements
Extensive knowledge of NCCI and CCI requirements for Medicare and Medicaid patients including MUE edits
Ability to implement or facilitate change utilizing change management techniques
Excellent oral and written communication skills; must be able to effectively interact and present information with clinical and non-clinical staff
Excellent customer service and organizational skills; detail- and task-oriented; effectively manages time and workload, and sets appropriate priorities
Possesses critical thinking and analytical skills
Ability to work independently and exercise professional judgment to meet daily operational demands
Ability to work as an effective team member
Demonstrates team-oriented, professional conduct when resolving issues which cross operational units within Revenue Cycle and/or across Eskenazi Health
Possesses Microsoft Excel skills including the ability to create and build new worksheets, import and sort data, and use basic formulas
Possesses Microsoft Word skills to summarize audit outcomes and write internal and external correspondence

Nice To Haves

Familiarity with information systems used at Eskenazi Health, including but not be limited to: EPIC, McKesson, NThrive, OnBase, G3, and Careweb preferred

Responsibilities

Coordinates, conducts and documents full or partial chart-to-bill audits for: Existing services to ensure revenue capture and documentation accuracy, Newly implemented hospital services, Defense audits requested by payers or outside agencies, Cost outlier and high balance accounts prior to billing or post third party vendor review, Other audits as assigned by management
Prepares written reports or trending data related to findings and facilitates sign off with leadership
Facilitates timely turnaround of audit results
Prepares written summaries of departmental audit results, which allow clinical leadership the ability to monitor and manage their revenue capture and documentation processes
Keeps Revenue Integrity Supervisor informed on various findings and communications with areas assigned for audit and/or process review
Notifies Charge Reconciliation, Charge Description Master (CDM), and Revenue Cycle Education Staff of pertinent audit issues requiring their intervention to remedy or correct
Works cooperatively within Revenue Cycle Support, and clinic/department leadership to ensure all charges are available within the Electronic Health Record (EHR) on an as-needed basis and according to department standards
Requests appropriate CDM additions, modifications, deletions and reactivations through the NThrive Workflow Tool
Develops and maintains a highly effective working relationship with Corporate Compliance, Finance, HIM, Revenue Cycle Services, Transition Support, and various clinic/department staff and their leadership
Provides education to clinical staff and clinic/department leadership on the appropriate utilization of charges in the Electronic Health Record (EHR) and suggests documentation improvements where appropriate
Identifies inappropriate billing patterns in accordance with hospital charging protocols and industry standards; makes recommendations for improvement of procedures, documentation, and revenue optimization opportunities
Works diligently to attain appropriate Revenue Integrity goals
Researches and resolves EHR billing, payer, and customer service related issues in a timely and compliant manner:
Retrieves and validates patient account information and charge-related documentation from multiple information systems and/or from hospital department personnel
Researches and resolves charge concerns identified through Charge Capture Audit (CCA) tool
Researches and resolves Revenue Guarding Edits that are built to identify accounts with missing charges
Validates that charges are on the correct account via EHR Charge Review work queues
Resolves National Correct Coding Initiative (NCCI) Edits, Correct Coding Initiative (CCI) Edits, and Medically Unlikely Edits (MUE)
Recommends and/or applies appropriate modifiers in support of medical services rendered
Researches and corrects Room & Bed and Observation Hour issues
Ensures patient satisfaction by resolving charge-related issues routed from Customer Service inquiries
Resolves charge issues associated with credit balance accounts
Enters account corrections and detailed comments in EHR to ensure a clear line of communication
Resolves coding requests that are sent to Revenue Integrity from the Coding department
Ensures appropriate revenue direction to ensure charges are accurately reported for financial reports
Researches, works proactively with charging departments, and resolves billing and/or charging issues; resolves Do Not Bill (DNB) Errors and Warnings