Key Facts

Remote From:

Full time

Mid-level (2-5 years)

English

Hard Skills

Medical Coding Auditing Revenue Management Health Information Management Patient Education And Counseling Reimbursement Regulations Auditing Clinical Documentation Finance Patient Education And Counseling Cross-Functional Collaboration

Other Skills

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Team Performance Management
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Collaboration
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Communication
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Analytical Skills
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Teamwork
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Detail Oriented
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Problem Solving

Roles & Responsibilities

High School Diploma or equivalent
2 years of medical coding experience
Active coding certification from AAPC or AHIMA
CPC certification required within 1 year of hire

Requirements:

Perform charge capture audits by comparing medical record documentation against the itemized bill and identify charging, coding or clinical documentation issues, coordinating with ancillary departments to resolve issues and notify leadership
Prepare modifications to patient charges as a result of audits to ensure revenue integrity and respond to RAC and other third-party payer audit requests in collaboration with Health Information Management and Patient Financial Services
Maintain an audit activity report to track and communicate audit activity with the associated financial impact, and analyze results to identify patterns, trends, variances and opportunities to improve revenue integrity
Initiate and lead performance improvement efforts through multidisciplinary teams to streamline processes, enhance charge capture and promote revenue cycle integrity; provide education to clinical departments on charge capture processes and documentation requirements; assist the CDM Coordinator with maintaining the Charge Description Master

Job description

Overview:

Must live in Florida.

The Charge Audit Specialist has responsibility to perform charge capture audits, initiate and lead performance improvement efforts to enhance charge capture, educate clinical departments and promote revenue cycle integrity.

Responsibilities:

Perform charge capture audits by comparing the medical record documentation against the itemized bill.
Identify charging, coding or clinical documentation issues and work with ancillary departments to resolve issues and notify appropriate leadership.
Prepare modifications to patient charges as a result of the audits and as required to ensure appropriate revenue integrity.
Respond to RAC and other third-party payer audit requests in collaboration with Health Information Management and Patient Financial Services.
Maintain an audit activity report to track and communicate audit activity with the associated financial impact. Analyze audit results to identify patterns, trends, variances and opportunities to improve revenue integrity.
Initiate and lead performance improvement efforts through multi-disciplinary teams to streamline processes, enhance charge capture and promote revenue cycle integrity.
Provide education to all clinical departments as needed to promote appropriate charge capture processes and improve understanding of the documentation requirements for specific charge activity.
Function as a resource to the CDM Coordinator when clinical information is needed to appropriately maintain the Charge Description Master.
Analyze and resolve patient claims being held by billing edits (i.e. NCCI/modifier 59, Medical necessity, Correct coding Initiative, Outpatient Code Editor (OCE), Inpatient Code Editor, Self-Administered and other claims requiring clinical expertise’s).
Compare UB04 charges to BAR charges and ensure all discrepancies are appropriate.
Performs all other duties as assigned by management within job scope.

Qualifications:

Education / Training