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 auditor performs routine, focused, retrospective, and risk-based audits across the healthcare revenue cycle, including registration, eligibility, authorization, charge capture, coding, billing, claims submission, payment posting, and account adjustments. The role reviews patient accounts and claims for accuracy, completeness, documentation support, regulatory and payer compliance, and reimbursement accuracy; evaluates controls; and identifies billing errors, inappropriate adjustments, missed or duplicate charges, and reimbursement variances. The position also assesses coding, clinical documentation, medical necessity, billing, and claims practices; reviews compliance with HIPAA privacy and security requirements; and supports risk assessments, investigations, external audits, payer audits, and regulatory inquiries. The auditor prepares defensible workpapers and reports, escalates significant findings, partners with operational leaders on corrective action plans, validates remediation, monitors trends, and develops education and process improvements. The role requires maintaining confidentiality, independence, and objectivity. This job description is not designed to cover every activity, duty, or responsibility. Duties, responsibilities, and activities may change at any time with or without notice.

Requirements

Bachelor’s degree in Business, Finance, Nursing, or Health Information Management is required.
RHI/RHIT/CCS/BSH license required, as stated in the posting.
At least 5 years of revenue cycle experience within an integrated healthcare system; hospital revenue integrity experience is preferred.
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.
Strong knowledge of healthcare revenue cycle operations, billing practices, and coding guidelines.
Ability to conduct comprehensive, objective, and risk-based audits.
Ability to interpret regulations, payer policies, medical records, financial data, and audit evidence.
Strong analytical, investigative, critical-thinking, and problem-solving skills.
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 promote teamwork and achieve department goals; interact appropriately with associates, physicians, and the general public.
Ability to maintain emotional stability and a calm disposition, and to demonstrate reliability, tact, honesty, and discretion.
Ability to adapt to changes in work schedules and interruptions.
Registered RN with a current RN license, or hospital inpatient coder with CCS certification, is preferred.

Nice To Haves

Registered RN with a current RN license.
Hospital inpatient coder with CCS certification.
Experience in a hospital revenue integrity department.

Responsibilities

Conduct routine, focused, retrospective, and risk-based audits across healthcare revenue cycle processes.
Perform end-to-end account audits to validate patient encounters, charges, documentation, claims, reimbursement, and financial transactions.
Evaluate compliance with internal policies, procedures, payer contracts, reimbursement methodologies, and 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 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, units of service, place of service, medical necessity, and other claim elements as applicable.
Review compliance with coding guidelines, NCCI edits, medically unlikely edits, payer billing policies, and coverage requirements.
Identify potential upcoding, undercoding, unbundling, duplicate billing, unsupported services, and other coding or billing practices that may create compliance exposure.
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, for charge reporting, coding, billing, and reimbursement accuracy.
Evaluate claim edits, denials, rebilling practices, late charges, and adjustments for accuracy and compliance.
Escalate potential improper payments, suspected fraud, waste, abuse, and significant billing compliance concerns through established reporting channels.
Assess revenue cycle workflows for compliance with HIPAA Privacy and Security Rules and organizational privacy and security policies.
Review access to PHI, minimum-necessary practices where applicable, secure record handling, and appropriate use and disclosure of information.
Identify privacy and security risks, including inappropriate access, unauthorized disclosures, insecure transmission, and deficiencies in handling or retaining sensitive information.
Ensure audit documentation and evidence containing PHI are accessed, stored, transmitted, and retained according to applicable requirements and organizational procedures.
Coordinate suspected privacy or security incidents with Privacy, Information Security, and Compliance teams; support privacy education for revenue cycle personnel.
Maintain working knowledge of CMS regulations, Medicare and Medicaid billing requirements, HIPAA, the False Claims Act, payer policies, and relevant federal and state 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 regulatory inquiries.
Prepare objective, accurate, and defensible audit workpapers documenting scope, methodology, evidence, findings, risk levels, and conclusions.
Escalate significant findings promptly to appropriate leadership and compliance personnel.
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 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 to address knowledge gaps and recurring compliance issues.
Recommend process improvements, system edits, automated controls, and preventive measures to strengthen revenue integrity.
Maintain confidentiality, independence, and objectivity throughout the audit process.
Work with associates to promote education, excellence, and job satisfaction; promote teamwork, implement procedures, and support department goals.
Interact appropriately with associates, physicians, and the general public; adapt to schedule changes and work interruptions.