Charge Capture Auditor

Revenue Integrity Charge Capture/Billing Auditor

The primary responsibility of the Revenue Integrity Charge Capture/Billing Auditor is to monitor clinical activities related to billing compliance. This position acts as a liaison between the facility and the Centralized Business Office. This position must have the ability to work effectively with payers, patients, clinicians, Health Information Management, and other employees.

Responsibilities and duties include:

• Identifying coding issues, including NCCI edits, modifiers and CPT assignment. Providing education and training regarding correct coding for revenue producing departments.
• Promotes the accuracy of coding/billing practices and identifies deficiencies and inaccuracies in recording charges for services rendered.
• Performs clinical reviews of medical records and associated billing to identify potential billing inaccuracies.
• Works closely with clinical departments to improve charging related workflow.
• Coordinates charge reviews for retrospective or concurrent, corporate special projects, and other billing reviews as identified.
• Performs other duties as assigned.
• Conducts audits to determine organizational integrity of billing facility and technical hospital fees, including detection and correction of documentation, coding and billing errors, and/or medical necessity of services billed.
• Evaluate the adequacy and effectiveness of internal and operational controls designed to ensure that practices lead to appropriate execution of regulatory requirements and guidelines related to facility and technical fee documentation, coding and billing, including federal and state regulations and guidelines, CMS and other third party payor billing rules.
• Applies consistent and standardized compliance audit methodology for sample selection, scoring and benchmarking, development and reporting of findings and repayment calculations.
• Assists the Revenue Integrity Director with charge capture process and electronic medical record functionality and makes recommendations for improvement, assisting with the development of documentation and coding tools and templates, and makes documentation, coding, and billing process improvement recommendations Serve as institutional subject matter experts and resources on interpretation and application of documentation and coding rules and regulations, medical necessity of services delivered, and conduct enterprise risk assessments of potential and detected compliance deficiencies.
• Assist with ad-hoc finance operations and revenue cycle projects.

Education & experience requirements:

• Prefer active certification or licensure as a RHIT, CCS, CCP, CPC or other recognized AHIMA certified coding credential; other healthcare related credential such as (but not limited to) LPN, LVN or RT
• Minimum 1 year of experience with charge capture auditing, clinical documentation integrity or similar role for a complex acute care institution preferred.

Abilities requirements:

• Broad knowledge of health care and/or hospital business office practices and principles.
• Knowledge and understanding of state and federal rules and regulations related to Medicare and MediCal.
• Must possess strong communication skills, both written and oral.
• Strong customer service skills that ensure a high level of customer satisfaction and promotes collaborative alliances and teamwork.
• Proficiency in Microsoft Office applications and others as required.

Physical requirements:

Body Positions: Sitting and standing for prolonged periods.

Body Movements: Arm and hand dexterity.

Body Senses: Must have command of close and distant sight, color perception and hearing.

Strength: Ability to lift and move up to 25-pounds.