Chart Auditor

AHMC Healthcare; Daly City (CA); On-site; USD 70,000 - 100,000; Full time

Job summary

AHMC Healthcare Inc. in Daly City seeks a meticulous Chart Auditor to review charges for patient services and uphold CMS compliance. You will perform concurrent and retrospective audits, coordinate with the business office, and help identify revenue leakage, presenting corrective actions to various departments.

The role emphasizes documenting findings, maintaining confidentiality, and contributing to ongoing improvements in revenue cycle processes.

Qualifications

• Education: High school diploma or equivalent; bachelor’s degree preferred.
• Experience: at least 2 years in healthcare; CPT understanding; billing experience preferred; CCS preferred.
• Skills: strong computer, analytical, and communication abilities; able to work independently.

Responsibilities

• Perform concurrent audits across Acute, SNF, and Subacute services with defined review counts.
• Conduct insurance/retrospective audits as requested and represent the hospital in reviews.
• Collect audit fees when required and prepare preliminary monthly audit reports.
• Analyze audit findings and advise departments on corrective actions to prevent revenue loss.
• Maintain patient confidentiality and uphold professional conduct standards.

Skills

CPT understanding

Billing experience

CMS Regulations knowledge

Independent worker

Strong communication

Strong analytical skills

Education

High school diploma or equivalent

Bachelor’s degree preferred

CCS certification preferred

Tools

MS Office

Job description

Overview

The Chart auditor is a detail oriented professional who assumes the responsibility and accountability for auditing charges for all patient services as well as maintaining compliance at Seton Medical Center and Medical Center Coastside.

Responsibilities

Key Functions & Responsibilities:

Perform concurrent audits: Acute: no less than 10 SNF: no less than 2 reviews Subacute : no less than 2 reviews for both inpatient and outpatient should be one-third of a single days revenue.

Perform insurance/retrospective audits: Represent the hospital in any retrospective audits requested by insurance companies that a concurrent audit has been done by the auditor, in addition to the other retrospective audits.

Retrospective audits.

Collect audit fees when required.

Perform audits requested by the business office: As assigned by the B.O. Director.

Perform special audits: As assign by the CFO or Controller

Analyze audit findings: Assist nursing and ancillary services in identifying areas of weakness resulting in lost revenue and inadequate documentation. Assist nursing and ancillary departments in implementing corrective actions to eliminate lost revenue. Provide continuous feedback to all revenue departments regarding audit findings.

Prepare the preliminary monthly audit report: Include the monthly findings for both concurrent and retrospective audits, i.e., monthly totals over and under charges. Identify all problem areas, and the proposed solutions.

Professional Conduct:

Employee has the willingness and ability to perform additional duties and responsibilities in differentareas of the department on an as-needed basis or as determined by management.

Follows established hospital and department policies. No more than 2 written substantiated complaints representing a breach of policy, procedure or professional behavior since last evaluation.

Demonstrates the philosophy of team concept.

Participates in group projects and staff meetings with suggestions that enhance the work environment and increase productivity.

Communicates well with supervisor reporting problems with equipment, supplies, or procedures. Requests assistance as appropriate.

Maintains patient confidentiality

Exhibits willingness to resolve problems as they arise.

Consistently projects positive professional image through appearance and behavior.

Attends 75% of staff meetings or reads and initials minutes.

Completes assigned work within shift.

Guest/Interdepartmental Relations As observed by representatives of management, all interactions are conducted in a professional manner.

Verbal and written feedback from patients, family members/significant others, medical staff, visitors and co- workers indicates behavior conducive to positive guest relations.

Consistently exhibits appropriate phone protocol (e.g., answers phones promptly, is courteous and helpful).

Consistently contribute to the team effort (e.g., assists co-workers when need is observed or upon request, offers constructive suggestions rather than complaints).

Consistently displays cheerful and positive attitude.

Professional Growth and Development

Completes annual safety updates within established time frames.

Completes general and departmental orientation within established time frames.

Attends 80% of in-service programs.

Maintains licensure/certification as appropriate

Performance Improvement

Consistently strives to understand, anticipate and meet the needs, expectations and satisfaction levels of patients and other \"customers\".

Errors, inefficiencies and inaccuracies are brought to management's attention with suggestions for improvement.

Develops innovative solutions to departmental problems. 1dentifies and implements methods of controlling costs or generating revenue while providing maximum value to both the patient/customer and the hospital.

Maximizes efficiency in all departmental operations. Measures progress against quality goals.

Department Specific Competencies Cultural Competency: Exhibits Culturally Responsive Attitude Including Flexibility, Empathy, Respect and Awareness of Communication Needs.

Qualifications

QUALIFICATIONS/JOB REQUIREMENTS:

EDUCATION: High school diploma or equivalent, Bachelor’s degree preferred

EXPERIENCE:

Minimum of two years of healthcare experience CPT understanding Billing experience preferred CCS preferred

OTHER SKILLS, ABILITIES & KNOWLEDGE:

Strong computer skills, including Microsoft programs Strong analytical skills Strong communication skills, written and oral

Solid problem solving abilities Ability to work independently with moderate supervision Demonstrates the ability to follow instructions well

Generates quality work product in a timely manner

Knowledge of CMS Regulations regarding patient charging