Revenue Integrity Auditor
Eskenazi Health

Job Info

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Division:Eskenazi Health

Sub-Division:Hospital

Req ID:9183

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 327-bed hospital and outpatient facilities both on and off of the Eskenazi Health downtown campus as well as at 10 Eskenazi Health Center sites located throughout Indianapolis.

Job 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 preferred

• Experience with Health Information Management (HIM), Facility/Physician Billing, Charge Description Master (CDM), Denials Management, Charge Integrity, Financial Analysis
• Three years of experience in a hospital or physician setting with extensive Revenue Cycle knowledge
• Two years of hospital audit experience with a concentration in High Balance and Cost Outlier and/or facility-based clinic audits

Accredited by The Joint Commission and named one of the nation's 150 best places to work by Becker's Hospital Review for four consecutive years and Forbes list of best places to work for women, and Forbes list of America's best midsize employers' 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 only verified adult burn center in Indiana, the first community mental health center in Indiana and the Eskenazi Health Center Primary Care - Center of Excellence in Women's Health, just to name a few.

Nearest Major Market: Indianapolis

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