Chargemaster Auditor, Full Time, First Shift

UC Health; Cincinnati (OH); On-site; USD 65,000 - 90,000; Full time

Job summary

UC Health is seeking a Charge Master Auditor to execute charge related audits across inpatient and outpatient accounts within our Cincinnati region. The role includes evaluating ICD/CPT/HCPCS codes, identifying charging discrepancies, and educating clinical departments on proper charging processes.

You will collaborate with Internal Audit and infusion clinical departments to improve data accuracy, reduce denials, and support timely billing through detailed audit results and constructive

Qualifications

• HS diploma or healthcare equivalent.
• Bachelor’s Degree preferred.
• CPMA certification or equivalent preferred.
• Minimum 1–2 years of experience; 3–5 years preferred.

Responsibilities

• Performs detailed and focused charge audits on inpatient and outpatient accounts.
• Evaluates the appropriateness of CPT/HCPCS codes based on documentation.
• Tracks, reports, and communicates audit findings including reimbursement and compliance information.
• Presents audit findings and recommends education to clinical departments.
• Partner with Internal Audit to perform charge related audits in the annual program.
• Educates infusion and other clinical departments on charge capture processes.

Skills

Auditing

Healthcare knowledge

Education

HS diploma

Bachelor’s Degree

Professional Medical Auditor CPMA

Job description

Job Description

At UC Health, we're proud to have the best and brightest teams and clinicians collaborating toward our common purpose: to advance healing and reduce suffering.

At UC Health, we're proud to have the best and brightest teams and clinicians collaborating toward our common purpose: to advance healing and reduce suffering. As the region's adult academic health system, we strive for innovation and provide world-class care for not only our community, but patients from all over the world. Join our team and you'll be able to develop your skills, grow your career, build relationships with your peers and patients, and help us be a source of hope for our friends and neighbors.

UC Health is committed to providing an inclusive, equitable and diverse place of employment.

The Charge Master Auditor is responsible for executing charge related audits. They assist in evaluating compliance related services that resolve charging discrepancies and provide charging related outreach education to clinical departments on charging processes and procedures. Instrumental in working Infusion related edits and providing education to our Infusion Clinical Departments.

Location

United States

Qualifications

HS diploma - Minimum Required - Healthcare. Bachelor’s Degree - Preferred Degree. | Professional Medical Auditor (CPMA) or an equivalent certification preferred. | Minimum Required: 1 - 2 Years equivalent experience. Preferred: 3 - 5 Years equivalent experience.

Responsibilities

Perform Audits

• Performs detailed and focused charge audits on inpatient and outpatient accounts.
• These can include defense, prebill, and cpt/charge code line item audits.
• Evaluates the appropriateness of services and procedures charged based on supporting documentation and evaluates the appropriateness of ICD, CPT, and HCPCS codes.
• Reviews audit results with management and staff and considers feedback from the internal/external customers as appropriate.
• Tracks, reports, and effectively communicates audit findings including reimbursement and compliance information.
• Enters and maintains charge audit results data.
• Present audit findings and assist in the development of constructive recommendations/education to clinical departments.
• Partner with Internal Audit to perform charge related audits in their annual audit program.

Charge Capture Outreach Education & Training

• Works with revenue producing clinical department managers to develop and provide educational sessions for staff concerning issues identified through the auditing process.
• Responds to clinical department questions and reviews cases as necessary, to assist with correct charge capture process and procedures.
• Attends educational sessions, training sessions and task forces sessions as directed.

Charge Edits

• Responsible for reducing Accounts Receivable on Unbilled Accounts by working charge related errors.
• Research and resolve a variety of issues relating to charge capture. Edit claims (DNB, Claim Edits, and Stop Bills) within scope of authority to meet and satisfy timely billing.
• Responsible for the analysis and necessary corrections of patient claims/accounts as it pertains to clean claim submissions and maintain work queues.

Process Improvement

• Identify areas of improvement to improve workflow to minimize errors and/or denials.
• Share and present findings and recommendation for improved workflow.

Other Duties As Assigned

• Provides occasional backup for other auditors or CDM team members.