Revenue Integrity Auditor
PRIMARY FUNCTION: The Revenue Integrity Auditor is responsible for the evaluation, monitoring, analysis and reporting of various revenue cycle functions that support the integrity of our organization’s revenue. This position will research, monitor, communicate and ensure adherence around organizational billing policies and regulatory requirements at Federal, State, and local levels that impact the revenue cycle.
REPORTS TO: Reports to Revenue Integrity Manager
SUPERVISIORY RESPONSIBILITIES: None
FLSA STATUS: Non-Exempt
ESSENTIAL FUNCTIONS OF THE JOB: (This list may not include all of the duties that may be assigned.)
1. Audit claims for medically appropriate services provided in both inpatient and outpatient settings, applying the appropriate coding compliance medical review guidelines, policies and rules.
2. Identifies opportunities for process improvement, develops and monitors action plans.
3. Collect and analyze data from coding audit to identify opportunities for process improvement and formulate recommendations and solutions based on audit trends and results in an effort to support the revenue cycle strategic initiatives. Monitors, audits and communicates outcomes to operational departments to ensure compliance with all billing related workflows.
4. Collaborate with other revenue teams, such as medical coding and collectors to identify and resolve coding and billing errors.
5. Assist with ensuring tip sheets and training materials are current and properly explain rules and laws specific to Florida.
Typical Working Conditions:
* Indoor work environment
* The position requires ability to sit for long periods. Some standing and walking may be necessary.
* Requires manual dexterity (use of hands or fingers) sufficient to operate a keyboard / computer.
* Reach above shoulder
* Reach outward
* Lift/Carry 10lbs or less
* Push/Pull 12 lbs. or less
Other Physical Requirements
* Sense of vision
* Sense of Sound
* Sense of Touch
* Ability to wear Personal Protective Equipment (PPE) as needed
Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI in accordance with organizational policy, Federal, State, and local regulations.
Education: High School Diploma or equivalent required.
Licensure/Certification: CPC, CCS or CPMA certification required. Any related certification from AHIMA or AAPC is preferred.
Experience: Minimum of 3 years of experience in revenue cycle management required. Previous healthcare experience required.
Knowledge, Skills & Abilities:
* Candidate must have strong experience performing medical records audits and documentation review.
* Proficient experience with ICD-10, CPT-4 or HCPCS coding.
* Ability to maintain high quality work while keeping strict deadlines.
* Ability to manage multiple tasks at the same time, including but not limited to desk audits and claims review.
* Ability to work independently and with team members effectively.