Clinical Revenue Auditor - 249637

Licensing and Certification Requirements: Current NYS licensure (RN, OT, PT, SLP, PA, Social Worker, Laboratory Technologist, Radiological Technologist and related professions). Certifications such as Certified Professional Medical Auditor (CPMA), Certified Inpatient Coder (CIC), Certified Coding Specialist (CCS), or Certified Healthcare Auditor (CHA) can be beneficial. Compensation: $96,000 - $140,00 annually. Actual salaries depend on a variety of factors, including experience, education, and operational need. Ideal background/candidate: Looking to hire 2 different people/skill sets. A nurse with strong clinical background or coding experience paired with a Coder who has experience with auditing on the payor side Overview: The Clinical Revenue Auditor is responsible for reviewing and verifying that all billable services and procedures provided to patients are accurately documented, coded, and submitted for payment. This position plays a key role in ensuring the financial health and compliance of the organization and bridges the gap between clinical care and medical billing and reimbursement. This position will report to the Senior Director. This role will serve as a crucial link in the revenue cycle, ensuring that patient care translates into accurate and timely reimbursement, safeguarding the financial well‑being of the organization and contributing to improved patient care standards. This role requires a unique blend of clinical expertise and financial acumen to ensure compliance with healthcare regulations and collaborate with staff to resolve issues and provide education. Responsibilities: Conduct thorough charge capture/clinical audits to assess the effectiveness of the billing process. Identify and rectify missing or incorrect charges, coding errors, and inconsistencies between documentation and billing. Perform root cause analysis to understand the underlying issues contributing to revenue leakage and develop corrective action plans. Optimize revenue capture by ensuring all billable services are appropriately charged, ultimately maximizing reimbursement for services rendered. Ensure adherence to coding guidelines and compliance regulations set by entities like the Centers for Medicare and Medicaid Services (CMS). Mitigate the risk of compliance violations, audits, and potential penalties related to billing errors. Streamline charge capture processes to improve efficiency and reduce administrative burden. Collaborate with clinical, billing, coding, and IT departments to address documentation issues and optimize workflows. Leverage charge capture software and analytics tools to identify gaps and areas for improvement in the charge capture process. Coordinate with payers to ensure timely handling of audit requests, review technical payer denials, determine if an appeal is warranted, and write and track appeal letters. Educate clinical teams and other stakeholders on appropriate documentation and charge capture practices to promote adherence to standards and improve overall process efficiency. Build effective, collaborative relationships with key stakeholders across departments. Resourceful in creating or fine‑tuning the processes necessary to complete the work along with the ability to organize people and activities. Challenge existing norms or courses of action to facilitate fully informed decision‑making. Help institute balanced decision‑making by identifying risks and opportunities. Establish and maintain strong working relationships with revenue cycle leaders, key stakeholders, and foster a strong working relationship with key strategic partners. Create feedback loops and enhancement pipelines informed by stakeholders and data. Ensure compliance with all HIPAA privacy and security standards. Conform to the established policies/ procedures/ processes/ Standards of Behavior. Performs other duties as required by the Senior Director Qualifications: Bachelors in an applicable healthcare-related profession; Masters is preferred 3-5 years of clinical experience is required. Key skills include a strong understanding of medical terminology and patient care, expertise in medical coding systems and healthcare regulations, analytical and problem‑solving abilities, excellent communication skills, and proficiency with EHR systems and audit software. Attention to detail and ethical judgment are also important. Demonstrated success in a large not-for-profit/academic health system facility or multi‑entity revenue cycle environment. Extensive knowledge of medical billing software and electronic medical records (Must have experience working with Epic). Knowledge of insurance and governmental programs, regulations, and billing processes (e.g., Medicare, Medicaid, etc.), managed care contracts and coordination of benefits is required. Working knowledge of medical terminology, and medical record coding experience are highly desirable. Excellent interpersonal skills and experience working with senior management and other leaders, along with the ability to communicate concepts to others. Knowledge of and experience in health care including government payers, applicable federal and state regulations, healthcare financing and managed care. Expected to stay updated on current medical billing and coding processes, clinical procedures, and relevant disease states. Demonstrated ability to engage in positive, powerful persuasion with individuals or groups with diverse opinions and/ or agendas, leading to outcomes that meet identified goals. Excellent verbal and written communication and organizational abilities. Accuracy, attentiveness to detail and time management skills are required. Ability to interact effectively with multidisciplinary teams, including physicians and other clinical professionals internally and externally. The ability to maintain a high level of positive energy/creativity during periods of elevated work demands. Ability to prioritize multiple objectives in a rapidly changing environment and deliver quality outcomes. Ability to develop and maintain effective relationships at all levels throughout the organization. #J-18808-Ljbffr Medix™