Revenue Integrity Auditor

Scope of Position

The Revenue Integrity Auditor will work with the Charge Description Master (CDM) unit to ensure the overall integrity of the CDM by maintaining a focus on accuracy, revenue cycle integrity, and compliance with third-party requirements. The Revenue Integrity Auditor processes accounts and charges via Work Queues within Epic to ensure accounts/charges move through the system timely to aid in cash flow. Provides support and services to Revenue Cycle, Financial Services, Information Technology Systems, Medical Information Management, and all clinical departments.

The Revenue Integrity Auditor is responsible for auditing charge processes and procedures throughout the organization to maintain charge integrity in compliance with CMS and other regulatory agencies. Responsible for maintaining current knowledge of the various regulatory agency guidelines and assure requirements are met along with accurate, complete and timely charge processes. Responsible for auditing current charge processes and, as needed, identifying correct charge processes. In addition, this position will assist in developing staff training materials to assure accurate charge processes are implemented and maintained.

Position Summary

The Revenue Integrity Auditor is responsible for monitoring, analyzing, and facilitating the entry of service and supply fees into various information systems. Ensure that charge capture applications are accurate and compliance standards are maintained. The Revenue Integrity Auditor will work with all cost centers and OSUP representatives to ensure the timeliness and accuracy of charge capture accuracy. This position will research, implement, and audit the use of tools such as Epics charge router, facility charge calculator and charge by documentation.

Minimum Qualifications

For Hire:

Required:

• Bachelor degree in Business, HIM, or related field, or equivalent combination of experience and education.

• Required License/Registration/Certification: RHIA, RHIT, CCS and/or COC credentials.

• Certification Requirement: Must obtain EPIC Resolute Hospital Billing Charging certification within the first 6 months of employment. Support and resources will be provided to assist in achieving this requirement.

• Minimum of two years of hospital clinical coding experience required; understand and interpret medical records, hospital bills, and the charge master.

• Proficiency in hospital and clinical record information systems and inpatient and outpatient coding methodologies.

• Knowledge and understanding of insurance terms (i.e. EOB, Stop Loss, etc.) and reimbursement methodologies.

• Understanding of revenue cycle functions, management and reporting in health care, and an overall operational knowledge of how those functions and activities of hospitals and medical clinics impact reporting.

• Foster a collaborative and team focused working environment.