Revenue Integrity Auditor

Department:

Employee Type:

Per Diem Type (if applicable):

Minimum Pay Range:

Job Description:

*** Remote/Local Position - Must be located within 60 miles of Placerville, CA ***

POSITION SUMMARY

Works independently performing program, compliance, and risk-based reviews of health care related activities to ensure accuracy of related medical record documentation, proper charge capture, ICD10 and CPT assignment, and billing in accordance with policies and reimbursement principles. Provides written audit summary of findings to include audit recommendations. Conducts revenue cycle investigations to determine and mitigate risk through findings, reports, and recommended actions. Responsible for coordinating, developing, and conducting educational training based on audit outcomes. Assists Corporate Compliance in maintaining the hospital's Corporate Compliance Program. 
 

POSITION QUALIFICATIONS

Education/Licensure/Certification:

• Experience with Health Information Management (HIM), Facility/Physician Billing, Charge Description Master (CDM), Denials Management, Charge Integrity, Financial Analysis

• Associate's/Technical Degree or equivalent combination of education/related experience: Required

• Bachelor's Degree: Preferred

• Five years' experience in healthcare coding inpatient, outpatient, rural health care and/or professional fee services: Required

• Five years' experience in auditing in clinic and/or facility revenue cycle: Preferred

• Certified Coding Specialist (CCS) or Certified Coding Specialist, Physician (CCS-Phy) or Certified Professional Coder (CPC) or Certified Professional Coder – Hospital (CPC-H) or Certified Coding Associate (CCA) Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT): Required

• Professional Medical Auditor (CPMA) or Certified E&M Coder (CEMC) or Certified E&M Auditor (CEMA) or Certified Documentation Integrity Practitioner (CDIP) or Certified Clinical Documentation Specialist- (CCDS): Preferred

Knowledge, training and experience:

• Requires extensive knowledge of various coding systems, including but not limited to CPT, ICD-10-CM, CPT-4, HCPCS, as well as medical terminology, anatomy and physiology, diagnostic and therapeutic tests: Required

• Knowledge of DRG and APC classifications and reimbursement methodologies: Preferred

• Extensive knowledge of billing processes and payer requirements with special emphasis on FSSA and CMS: Preferred

• Extensive knowledge of NCCI and CCI requirements for Medicare and Medicaid patients including MUE edits: Preferred

Skills:

• Excellent oral and written communication skills; ability to effectively interact and present information with clinical and non-clinical staff: Required.

• Excellent customer service and organizational skills; detail- and task-oriented; effectively manages time and workload; ability to set appropriate priorities and effectively work remotely: Required.

• 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

• Familiarity with information systems including, but not limited to: Epic, nThrive, OnBase.