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Revenue Integrity Auditor

Company: Methodist Health System
Location: Omaha
Posted on: May 6, 2021

Job Description:

  • Purpose of Job
    • The Revenue Integrity Auditor is responsible for coordinating and facilitating clinical review functions for all entities to ensure all appropriate billable charges are captured as documented within the patient record.
      • Reviews medical documentation and compares to posted charges to determine whether services charged are supported by the medical record.
      • Serves as a liaison between Finance, Charge Services, Health Information Management (HIM) and other departments.
      • During the course of a review the Auditor will educate clinical staff and department leaders of missed charges, late charges, or incomplete documentation which doesn't support billed charges.
      • May assist in external insurance audits or special projects as needed.
      • Job Requirements
        • Education
          • Associates or Bachelors Degree in business, healthcare administration, or related area required.
          • Bachelors of Nursing (BSN) preferred.
          • Experience
            • Demonstrated knowledge of clinical documentation processes and procedures.
            • Minimum 5 years experience working in a hospital setting with significant exposure to orders/charge processes and electronic medical records (EMR).
            • License/Certifications
              • Current valid Nebraska Registered Nurse (RN) License, valid compact multistate license to work in Nebraska, or a temporary permit while awaiting licensure required.
              • Skills/Knowledge/Abilities
                • Knowledge of Medicare Severity-Diagnosis Related Group (MS-DRG), All Patient Refined-Diagnosis Related Group (APR-DRGs), Medicare Ambulatory Payment Classification (APC), Enhanced Ambulatory Patient Grouping (EAPG).
                • Excellent time management and attention to detail skills.
                • Excellent written and oral communication skills.
                • Self-starter with ability to work with minimal oversight.
                • Ability to effectively work in a team environment.
                • Strong independent problem-solving skills using critical thinking, logic and reasoning to assess and resolve problems.
                • Excellent computer skills, including proficiency in Microsoft Office Suite.
                • Physical Requirements
                  • Weight Demands
                    • Light Work - Exerting up to 20 pounds of force.
                    • Physical Activity
                      • Not neccessary for the position (0%):
                        • Climbing
                        • Crawling
                        • Kneeling
                        • Occasionally Performed (1%-33%):
                          • Balancing
                          • Carrying
                          • Crouching
                          • Distinguish colors
                          • Grasping
                          • Lifting
                          • Pulling/Pushing
                          • Standing
                          • Stooping/bending
                          • Twisting
                          • Walking
                          • Frequently Performed (34%-66%):
                            • Fingering/Touching
                            • Keyboarding/typing
                            • Reaching
                            • Repetitive Motions
                            • Sitting
                            • Speaking/talking
                            • Constantly Performed (67%-100%):
                              • Hearing
                              • Seeing/Visual
                              • Job Hazards
                                • Not Related:
                                  • Chemical agents (Toxic, Corrosive, Flammable, Latex)
                                  • Biological agents (primary air born and blood born viruses) (Jobs with Patient contact) (BBF)
                                  • Physical hazards (noise, temperature, lighting, wet floors, outdoors, sharps) (more than ordinary office environment)
                                  • Equipment/Machinery/Tools
                                  • Explosives (pressurized gas)
                                  • Electrical Shock/Static
                                  • Radiation Alpha, Beta and Gamma (particles such as X-ray, Cat Scan, Gamma Knife, etc)
                                  • Radiation Non-Ionizing (Ultraviolet, visible light, infrared and microwaves that causes injuries to tissue or thermal or photochemical means)
                                  • Mechanical moving parts/vibrations
                                  • Essential Job Functions
                                    • Essential Functions I
                                      • Performs pre- and post-payment charge audits to identify potential lost revenue opportunities.
                                      • Provides education to clinical staff and department managers for effective charge capture.
                                      • Identifies opportunities for missed charges and inappropriate billing patterns in accordance with hospital charging protocols and industry standards.
                                      • Develops and maintains an effective working relationship with Charge Services, Clinical coding, clinical staff, and department managers to improve processes.
                                      • Performs Charge audits and prepares reports to identify missed revenue opportunities for the corporate compliance program.
                                      • Works with clinical departments to ensure audit findings are addressed and assist with best practices for charge/order entry moving forward.
                                      • Analyzes root causes for duplicate, missing, late charges, or incorrectly charged services and items and provide education as needed.
                                      • Keeps abreast of CMS and other federal regulations concerning charge capture.
                                      • Keeps Reimbursement Supervisor informed of audit findings and communicates findings with clinical staff and department management team.
                                      • Addresses HIM/Coding staff questions regarding charge issues as needed.
                                      • Essential Functions II
                                        • Participates in mandatory in-services and/or CE programs as mandated by policies and procedures/external agencies and as directed by management.
                                        • Follows and understands the mission, vision, core values, Employee Standards of Behavior and company policies/procedures.
                                        • Other duties as assigned.

Keywords: Methodist Health System, Omaha , Revenue Integrity Auditor, Accounting, Auditing , Omaha, Nebraska

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