Compliance & Charge Capture Auditor

Carle Health; Urbana (IL); On-site; USD 50,000 - 80,000; Full time

Job summary

An established industry player in healthcare is seeking a detail-oriented auditor to ensure accurate billing and compliance with regulatory standards. In this pivotal role, you will conduct daily audits of patient accounts, analyze documentation, and track charge anomalies while providing essential training to clinical staff. Your expertise will contribute to maintaining high standards in patient care and billing accuracy. Join a dynamic team dedicated to excellence in healthcare and make a significant impact on operational efficiency and patient satisfaction.

Qualifications

• Must obtain CPC-A, CCA, RHIT, and Epic Certification within specified timeframes.
• Strong analytical skills to track and trend charge anomalies.

Responsibilities

• Perform daily audits of patient accounts and ensure accurate billing.
• Analyze documentation to confirm charges align with regulations.
• Conduct audits and provide training to clinical staff as needed.

Skills

Auditing

Data Analysis

Attention to Detail

Communication

Education

Certified Professional Coder - Apprentice (CPC-A)

Certified Coding Associate (CCA)

Registered Health Information Technician (RHIT)

Epic Certification

Certified Professional Coder - Hospital (CPCH)

Certified Coding Specialist (CCS)

Registered Health Information Administrator (RHIA)

Tools

Epic

Job description

Responsible for auditing accounts prior to billing according to coding, regulatory, and payor policy guidelines. Addresses debit and credit charging errors to assure correct final bills. Audits documentation to make sure the chart documentation matches the charges on the patient account. Tracks and analyzes data trends, reporting those trends back to clinical directors and providing additional education to clinical staff where appropriate. Performs daily audits on all Inpatient and Observation accounts. Responsible for quarterly focused audits of areas with suspected or confirmed problems.

Responsibilities

1. Perform daily audits of all Inpatient, Observation, ED and Outpatient Infusion via WQ monitoring, review of department revenue variance, and collaboration with operational areas.
2. For Observation accounts, auditor is responsible for analyzing number of hours charged and whether all are appropriate according to regulation. If not, auditor must credit the appropriate number of hours.
3. In partnership with Revenue Integrity leadership, plans, coordinates, and conducts audits/internal control evaluations and reviews as scheduled.
4. Presents project results to leadership team.
5. Responsible for tracking and trending charge anomalies.
6. Maintains knowledge of clinical documentation standards and charge related regulations and standards.
7. Applies knowledge to ensure that charges are accurate and supportable according to payer and regulatory requirements.
8. Responsible for ad hoc training/retraining of clinical staff if director asks.
9. Responsible for printing daily IP and OBS census and analyzing documentation to make sure correct charges are entered.
10. If there is documentation, but no charge, auditor is responsible for adding appropriate charge to account.
11. If there is a charge, but no documentation, auditor is responsible to contact the department director or manager and ask if charge is appropriate, and if so ask if the nurse can still document.
12. For Observation accounts, auditor is responsible to add all IV infusion and injection charges according to CMS guidelines.
13. Plan, coordinate and conduct audits, internal control evaluations and reviews as scheduled.
14. Prepare neat, well organized and documented work papers, reports or memorandums.
15. Responsible for processing all bills received for clinical services obtained from an outside company.
16. Auditor must communicate with the clinical dept. director ordering that test to obtain authorization to pay the bill and interface with Finance and Revenue Cycle to get the bill paid.
17. Manages large complex projects, investigates and analyzes issues at a high level with strong attention to detail.
18. Completes and/or attends training and education sessions as assigned by leadership.

Qualifications

Certifications: Certified Professional Coder - Apprentice (CPC-A) within 1 year - American Academy of Professional Coders (AAPC); Certified Coding Associate (CCA) within 1 year - American Health Information Management Association (AHIMA); Registered Health Information Technician (RHIT) within 1 year - American Health Information Management Association (AHIMA); Epic Certification within 18 months - EPIC; Certified Professional Coder - Hospital (CPCH) within 1 year - American Academy of Professional Coders (AAPC); Certified Coding Specialist (CCS) within 1 year - American Health Information Management Association (AHIMA); Registered Health Information Administrator (RHIA) within 1 year - American Health Information Management Association (AHIMA).

Seniority Level

Associate

Employment Type

Full-time

Job Function

Health Care Provider

Industries

Public Health