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