Revenue Integrity Compliance Auditor

Albany Medical Center • Albany, NY

1d • $70,068 - $108,605 • Onsite

About The Position

Under the direction of the Revenue Integrity Audits Manager, this position is responsible for providing audit and research support to physicians, advanced practice professionals, professional fee billing staff, clinic staff, administrators, and other affected personnel on documentation and billing requirements. Using established auditing and research techniques, determines the adequacy of medical records documentation, coding and billing for all providers across all clinical specialties. This position reads, interprets, and distributes coding and billing guidelines to all departments to ensure regulatory compliance.

Requirements

• Associate's Degree in health care-related or business-related field - required
• Two years of experience in auditing, compliance and/or coding - required
• RHIT, RHIA, CCS, or CPC - required

Nice To Haves

• Bachelor's Degree in nursing - preferred
• Minimum of three years' experience in a clinical setting - preferred
• Epic experience - preferred
• Registered Nurse (RN) - preferred
• Equivalent combination of relevant education and experience may be substituted as appropriate.

Responsibilities

• Exemplifies the AMHS Values and Code of Conduct, while striving to identify compliance risk through effective and timely review of RAC Audit requests, ensuring timely appeals, as appropriate, and reporting any identified risks to Legal Services and Corporate Compliance Departments.
• Ensures immediate action is taken on any issues identified by Legal Services or Corporate Compliance.
• Builds and nurtures collaborative supporting relationships with the AMHS executive team, clinical chairs, faculty, clinicians, and other leaders across the health system and encourages, promotes, and advocates staff to ensure integration of new processes across all departments.
• Review clinical documentation within the patient medical record and charges in financial system in response to edits and/or inquiries from third-party payers
• Resolves edits based on regulatory and/or payer specific guidelines
• Generates appeal letters in response to denials received from payers and updates information in patient accounting system to reflect actions taken
• Works collaboratively with members of the revenue cycle, information systems and clinical departments toward ensuring accuracy of charges on patient accounts
• Performs audits on patient accounts as requested and tracks results for ongoing review by revenue cycle performance improvement and/or leadership
• Engages in end- to end testing scenarios as needed to ensure new charge generation and/or revisions are accurate within the information system and populate correctly in the financial billing system
• Performs review of clinical documentation within the electronic medical record and validates and/or add charges to patient encounter as appropriate
• Research and answers billing and documentation questions or problems submitted by faculty, advanced practice professionals, departments, billing staffï and others to ensure compliance with specific payer regulations
• Reviews documentation or coding patterns by a clinician, division or department that poses a compliance risk and provides input on recommended solutions
• Keeps current with third party regulations with emphasis on Medicare billing, teaching physician regulations, Current Procedural Terminology, ICD-IO-CM Coding, and professional fee billing.
• Acts as source of reference for enterprise on regulatory, reimbursement or billing changes, and develops and implements training to maintain and support compliance with federal and state regulations.
• Maintains a working knowledge of revenue cycle process to aid in the implementation of regulatory standards that assist compliant charge capture practices.
• Monitors compliance with corporate, federal, and state guidelines to include review of commercial bulletins for HCPCS/CPT code changes and additions and billing unit rule changes.
• Performs other duties as assigned.

Benefits

• Excellent health care coverage with no copay at Albany Medical Center providers
• A wide array of services and programs to support emotional, physical, and mental wellbeing

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree