Revenue Integrity Auditor - Revenue Integrity - FT Days

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

Who We Are

UCI Health is one of California's largest academic health systems and the clinical enterprise of the University of California, Irvine. Established on July 1, 1976, UCI Health has grown into a 1,461-bed health system that includes UCI Health - Orange, UCI Health - Irvine, four Community Network hospitals and a growing network of ambulatory care centers across Orange and Los Angeles counties.

Who We Are

UCI Health is one of California's largest academic health systems and the clinical enterprise of the University of California, Irvine. Established on July 1, 1976, UCI Health has grown into a 1,461-bed health system that includes UCI Health - Orange, UCI Health - Irvine, four Community Network hospitals and a growing network of ambulatory care centers across Orange and Los Angeles counties.

Your Role on the Team

Position Summary

The incumbent is responsible for performing comprehensive Revenue Cycle audit reviews, which include identifying areas of risk, determination of regulatory and compliance risk, and ongoing audit necessity, as well as determining denial prevention opportunities. This position will focus on evaluating the adequacy and effectiveness of internal and operational controls to ensure that all regulatory and billing compliance guidelines are being met in accordance with hospital and professional billing standards. Audit reviews will include hospital and professional medical record documentation, charge data, coding data, and denial trends, to assess risks and determine potential impacts. The candidate should have extensive knowledge of medical terminology and hold a coding certification, along with experience working with various health plan products such as Medicare, Medi-Cal, HMO, PPO, and Managed Care, as well as private insurance and CMS guidelines. Previous experience in a hospital setting, particularly with split fee billing and a focus on hospital billing, is preferred. This role involves preparing comprehensive audit reports that quantify impacts on both gross and net revenue, identifying opportunities for educational initiatives, and implementing the corrective measures for process improvements.

Required Qualifications

What It Takes to be Successful

• Proficient EXCEL, WORD, PowerPoint skills
• Must possess the skill, knowledge and ability essential to the successful performance of assigned duties
• 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)
• Must demonstrate customer service skills appropriate to the job
• Knowledge of health information systems for computer application to medical records
• Knowledge of ICD-10-CM & CPT coding conventions to code medical record entries; abstract information from medical records; read medical record notes and reports; set accurate Diagnostic Related Groups
• Knowledge of DRG/APC reimbursement
• Five years’ experience in hospital and physician billing, charging practices.
• Five years’ auditing experience working in acute care hospital and academic institution
• Familiarity of audit software packages
• Experience in providing both verbal and written feedback or education directly to clinical and/or billing staff regarding coding, charging, documentation, payor authorization, and claim processing requirements.
• Excellent written and verbal communication skills in English
• Ability to work effectively both as a team player and leader
• Ability to use sound judgment and make informed decisions
• Ability to use computer to accomplish data input, manipulation, and output
• Ability to manage, organize, prioritize, multi-task and adapt to changing priorities
• Ability to maintain a work pace appropriate to the workload
• Ability to establish and maintain effective working relationships across the Health System, School of Medicine, UCI Research Administration and other UC System campuses

Preferred Qualifications

• Knowledge of charge capture workflows and CDM, CRRC
• Knowledge of University and Medical Center organizations, policies, procedures and forms
• Experience with Epic EMR and billing

Total Rewards

We offer a wealth of benefits to make working at UCI even more rewarding. These benefits may include medical insurance, sick and vacation time, retirement savings plans, and access to a number of discounts and perks. Please utilize the links listed here to learn more about our compensation practices and benefits.

Conditions Of Employment

The University of California, Irvine (UCI) seeks to provide a safe and healthy environment for the entire UCI community. As part of this commitment, all applicants who accept an offer of employment must comply with the following conditions of employment:

• Background Check and Live Scan
• Employment Misconduct*
• Legal Right to Work in the United States
• Vaccination Policies
• Smoking and Tobacco Policy
• Drug Free Environment
• Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts a conditional offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer.

The following additional conditions may apply, some of which are dependent upon business unit or job specific requirements.

• California Child Abuse and Neglect Reporting Act
• E-Verify
• Pre-Placement Health Evaluation

Details of each policy may be reviewed by visiting the following page: https://hr.uci.edu/new-hire/conditions-of-employment.php

Closing Statement

The University of California is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected categories covered by the UC Anti-Discrimination Policy.

We are committed to attracting and retaining a diverse workforce along with honoring unique experiences, perspectives, and identities. Together, our community strives to create and maintain working and learning environments that are inclusive, equitable, and welcoming.

UCI provides reasonable accommodations for applicants with disabilities upon request. For more information, please contact UCI's Employee Experience Center (EEC) at [e-mail] or at [phone], Monday - Friday from 8:30 a.m. - 5:00 p.m.

Consideration for Work Authorization Sponsorship

Must be able to provide proof of work authorization