Revenue Integrity Auditor — Hospital Billing & Coding Expert

UCI Health; Irvine (CA); On-site; USD 90,000 - 120,000; Full time

Job summary

UCI Health is seeking a seasoned Revenue Cycle Audit Specialist to perform comprehensive reviews of hospital and professional billing processes. You will evaluate internal controls, analyze billing data, and identify opportunities to improve accuracy and compliance with CMS, commercial payers, and government programs.

The role requires extensive knowledge of medical terminology, multiple coding certifications, and strong analytical and communication skills within a hospital setting and academic

Qualifications

• Proficient EXCEL, WORD, PowerPoint skills.
• Must possess multiple current Coding Certifications (i.e., CPC, COC, or AHIMA equivalent).
• Must possess experience reviewing and interpreting CMS, Commercial and Government payer coding and payment requirements.
• Must possess a current Coding Certification (CPC, COC, or AHIMA equivalent).
• Excellent written and verbal communication skills in English.
• Knowledge of ICD-10-CM & CPT coding conventions to code medical record entries; abstract information from medical records.
• Knowledge of DRG/APC reimbursement.
• Five years’ auditing experience in acute care hospital and academic institution.

Responsibilities

• Perform comprehensive Revenue Cycle audit reviews identifying risk areas and regulatory/compliance requirements.
• Evaluate adequacy and effectiveness of internal controls to ensure compliance with hospital and professional billing standards.
• Audit hospital and professional documentation, charge data, coding data, and denial trends to assess risks and potential impact.
• Prepare comprehensive audit reports quantifying impacts on gross and net revenue; identify educational opportunities and implement corrective actions.

Job description

UCI Health is seeking a seasoned Revenue Cycle Audit Specialist to perform comprehensive reviews of hospital and professional billing processes. You will evaluate internal controls, analyze billing data, and identify opportunities to improve accuracy and compliance with CMS, commercial payers, and government programs.

The role requires extensive knowledge of medical terminology, multiple coding certifications, and strong analytical and communication skills within a hospital setting and academic