Revenue Integrity Auditor

Eskenazi Health; Indianapolis (IN); On-site; USD 65,000 - 90,000; Full time

Job summary

Eskenazi Health in Indianapolis seeks a Revenue Integrity Auditor to perform pre- and post-payment chart audits, ensuring proper charge capture and compliant billing. You will collaborate with HIM, CDI, Coding, and other teams to resolve denials and improve documentation.

You will prepare audit reports, educate clinical staff, and help optimize revenue integrity processes across the EHR and CDM systems, including EPIC, McKesson, and NThrive platforms.

Qualifications

• Experience in HIM or Revenue Cycle audit in a hospital/physician setting.
• Strong knowledge of ICD-10-CM, CPT-4, HCPCS, and medical terminology.
• Ability to communicate audit findings clearly to clinical and non-clinical stakeholders.

Responsibilities

• Conduct full or partial chart-to-bill audits for existing and new services.
• Identify and address charge capture issues and denials in collaboration with Revenue Cycle teams.
• Prepare written summaries and trend data to inform leadership decisions.

Skills

ICD-10-CM

CPT-4

NCCI/CCI Edits

Education

Associate's degree required

Bachelor's degree preferred

Certified coder credentials (CCS/CPC/etc.)

Tools

EPIC

McKesson

NThrive

OnBase

G3

Job description

Division:Eskenazi Health Sub-Division: Hospital Req ID: 26635 Schedule: Full Time Shift: Days

Eskenazi Health serves as the public hospital division of the Health & Hospital Corporation of Marion County. Physicians provide a comprehensive range of primary and specialty care services at the 333-bed hospital and outpatient facilities both on and off of the Eskenazi Health downtown campus including at a network of Eskenazi Health Center sites located throughout Indianapolis.

FLSA Status ExemptJob Role Summary The Revenue Integrity Auditor is responsible for pre- and post-payment auditing of medical records and associated clinical documentation to ensure proper charge capture, billing in accordance with standard billing policies and reimbursement principles. This position is responsible for assisting Revenue Cycle Services, Health Information Management (HIM), Coding, Clinical Documentation Improvement (CDI), and other departments with resolution of billing issues and/or denials requiring clinical expertise, participating in external audit requests, and special projects as needed. This position also serves as an audit outcome educator with clinical staff in clinic and department settings.

Essential Functions and Responsibilities

• Coordinates, conducts and documents full or partial chart-to-bill audits for:
  Existing services to ensure revenue capture and documentation accuracy
  Newly implemented hospital services
  Defense audits requested by payers or outside agencies
  Cost outlier and high balance accounts prior to billing or post third party vendor review
  Other audits as assigned by management
  Prepares written reports or trending data related to findings and facilitates sign off with leadership
  Facilitates timely turnaround of audit results
  Prepares written summaries of departmental audit results, which allow clinical leadership the ability to monitor and manage their revenue capture and documentation processes
  Keeps Revenue Integrity Supervisor informed on various findings and communications with areas assigned for audit and/or process review
  Notifies Charge Reconciliation, Charge Description Master (CDM), and Revenue Cycle Education Staff of pertinent audit issues requiring their intervention to remedy or correct
  Works cooperatively within Revenue Cycle Support, and clinic/department leadership to ensure all charges are available within the Electronic Health Record (EHR) on an as-needed basis and according to department standards
  Requests appropriate CDM additions, modifications, deletions and reactivations through the NThrive Workflow Tool
  Develops and maintains a highly effective working relationship with Corporate Compliance, Finance, HIM, Revenue Cycle Services, Transition Support, and various clinic/department staff and their leadership
  Provides education to clinical staff and clinic/department leadership on the appropriate utilization of charges in the Electronic Health Record (EHR) and suggests documentation improvements where appropriate
  Identifies inappropriate billing patterns in accordance with hospital charging protocols and industry standards; makes recommendations for improvement of procedures, documentation, and revenue optimization opportunities
  Works diligently to attain appropriate Revenue Integrity goals
  Researches and resolves EHR billing, payer, and customer service related issues in a timely and compliant manner:
  Retrieves and validates patient account information and charge-related documentation from multiple information systems and/or from hospital department personnel
  Researches and resolves charge concerns identified through Charge Capture Audit (CCA) tool
  Researches and resolves Revenue Guarding Edits that are built to identify accounts with missing charges
  Validates that charges are on the correct account via EHR Charge Review work queues
  Resolves National Correct Coding Initiative (NCCI) Edits, Correct Coding Initiative (CCI) Edits, and Medically Unlikely Edits (MUE)
  Recommends and/or applies appropriate modifiers in support of medical services rendered
  Researches and corrects Room & Bed and Observation Hour issues
  Ensures patient satisfaction by resolving charge-related issues routed from Customer Service inquiries
  Resolves charge issues associated with credit balance accounts
  Enters account corrections and detailed comments in EHR to ensure a clear line of communication
  Resolves coding requests that are sent to Revenue Integrity from the Coding department
  Ensures appropriate revenue direction to ensure charges are accurately reported for financial reports Researches, works proactively with charging departments, and resolves billing and/or charging issues; resolves Do Not Bill (DNB) Errors and Warnings

Job Requirements

• Medical Technician, LPN or RN, with current state licensure OR certified R.H.I.A., R.H.I.T., CCS, CCS-P, CPC, CPC-H, CCA, OR Associate's degree required; bachelor's degree preferredExperience with Health Information Management (HIM), Facility/Physician Billing, Charge Description Master (CDM), Denials Management, Charge Integrity, Financial AnalysisThree years of experience in a hospital or physician setting with extensive Revenue Cycle knowledgeTwo years of hospital audit experience with a concentration in High Balance and Cost Outlier and/or facility-based clinic auditsKnowledge, Skills & Abilities Requires extensive knowledge of various coding systems, including but not limited to ICD-10-CM, CPT-4, HCPCS, as well as medical terminology, anatomy and physiology, diagnostic and therapeutic testsKnowledge of DRG and APC classifications and reimbursement methodologiesExtensive knowledge of billing processes and payer requirementsExtensive knowledge of NCCI and CCI requirements for Medicare and Medicaid patients including MUE edits Ability to implement or facilitate change utilizing change management techniquesExcellent oral and written communication skills; must be able to effectively interact and present information with clinical and non-clinical staffExcellent customer service and organizational skills; detail- and task-oriented; effectively manages time and workload, and sets appropriate prioritiesPossesses critical thinking and analytical skillsAbility to work independently and exercise professional judgment to meet daily operational demandsAbility to work as an effective team memberDemonstrates team-oriented, professional conduct when resolving issues which cross operational units within Revenue Cycle and/or across Eskenazi HealthPossesses Microsoft Excel skills including the ability to create and build new worksheets, import and sort data, and use basic formulasPossesses Microsoft Word skills to summarize audit outcomes and write internal and external correspondenceFamiliarity with information systems used at Eskenazi Health, including but be limited to: EPIC, McKesson, NThrive, OnBase, G3, and Careweb preferred

Accredited by The Joint Commission and named as one of Indiana's best employers by Forbes magazine for two consecutive years and the top hospital in the state for community benefit by the Lown Institute, Eskenazi Health's programs have received national recognition while also offering new health care opportunities to the local community. As the sponsoring hospital for Indianapolis Emergency Medical Services, the city's primary EMS provider, Eskenazi Health is also home to the first adult Level I trauma center in Indiana, the first verified adult burn center in Indiana and Sandra Eskenazi Mental Health Center, the first community mental health center in Indiana, just to name a few.Nearest Major Market: Indianapolis