The Revenue Integrity Senior Charge Auditor is responsible for monitoring and ensuring the charge integrity of chargeable and billed patient care services in accordance with industry best practices within local, Federal, and State regulations and guidelines. Incumbent will perform departmental, focused, or specific account charge audits for accuracy to identify areas of charge capture improvement, staff education needs, and prepare unbiased charge audit summary results to share with hospital leadership and executive teams to prevent revenue leakage. The Senior Charge Auditor will also serve as a liaison to facilitate charge education and process improvements.
Responsibilities
Conducts comprehensive charge audit, charge analytics, research root causes, and recommends solutions to improve workflows, increase efficiency, and reduce revenue leakage. Utilizes analytics to identify missing charges, verify charge integrity or compliance issues.
Prepares written charge audit results to communicate potential risks and recommends charge capture process improvements to reduce revenue leakage.
Provides charge education and training to department leaders and staff on current rules and regulations to increase efficiency, charge awareness, accuracy, to reduce charge compliance risks.
Serves as an integral part of the Charge Audit committee to report audit findings to local facility leadership and Executive Teams.
Reviews daily Suspense Report for items requiring charge audit review and communicates the needed charge corrections to the appropriate department.
Functions as Revenue Integrity Liaison between the CBO, HIM, Allscripts, Nursing, Compliance, and other departments to facilitate charge related process improvements, education, and charge compliance.
Qualifications
Required Qualifications:
Bachelor’s degree or relevant Charge Audit experience
Seven (7) to Ten (10) years previous audit experience in a hospital or provider charge audit setting
Must be able to effectively communicate verbally and in written formats
Computer literacy and proficiency
Knowledge of CPT, ICD10, HCPCS Coding Structure
Expertise in clinical documentation
Extensive understanding of CCI edits, CPT, HCPCS, ICD-10-CM, and Revenue codes.
Extensive knowledge of Revenue Cycle and Revenue integrity Processes, Registration, Medical Records Coding, Government, and Managed Care billing rules, coverage, payment, and compliance.
Ability to read medical charts and dictation to understand chargeable services performed and correlation to chargeable services on the bill (UB-04).
Must demonstrate expert customer service skills
Preferred Qualifications:
CHRI, CRIP, AHIMA or other Revenue Integrity certifications
CPC, CCS, CPMA, or other coding certifications
Pay Rate: Min - $93,800 | Max - $140,700
About Us
Prospect Medical Holdings' ability to deliver quality, compassionate care during the unprecedented pandemic affirms the original vision of its founders. This is the fulfillment of the hopes Prospect’s founders had for the company, and proof that a clear vision, an insightful operating model, and a commitment to communities and our employees, born in the past, remains the way of the future.
Every day, our more than 11,000 affiliated physicians and 18,000 employees at 17 hospitals, 165 outpatient centers and 28 medical groups provide nationally recognized care in six states. Our comprehensive network of quality healthcare services is designed to offer our patients and 600,000 members highly coordinated, personalized care tailored to the unique needs of each community we serve—many of which provide essential medical services to underserved communities as safety-net hospitals.
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Finance and Accounting/Auditing
Industries
Mental Health Care, Medical Practices, and Hospitals and Health Care
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