GENERAL SUMMARY:

Reporting to the Manager, Revenue Integrity, the Revenue Integrity Auditor must have a comprehensive understanding of medical terminology, coding, charge entry, and healthcare revenue cycle processes. The Revenue Integrity (RI) Auditor provides support for timely, accurate and inclusive charge capture, coding, billing functions and revenue routing, through evaluation and interpretation of payer updates, performance of record audits, work queue review, presentation of staff education and other related activities. The RI Auditor coordinates processes between clinical operations and revenue cycle departments ensuring that the accounts audited reflect proper documentation, charge capture, coding, and billing to support proper payment. The RI Auditor understands HFH payor contracts and reimbursement methodologies. Works collaboratively with Revenue Integrity staff to identify charge system weakness, recommends process improvement and other changes provides education, and tracks utilization. This position is integral to the Revenue Integrity Team to assist in ensuring patient services are supported by clinical documentation, appropriately coded, accurately charged, and the related revenue is recorded in the proper department. 

EDUCATION/EXPERIENCE REQUIRED:

Associate degree in Business Administration, Healthcare Administration, Nursing or related field, or two (2) years of related experience in lieu of Associate degree. Two (2) years of experience in healthcare revenue cycle/audit processes. EPIC experience, preferred. Hospital billing and healthcare finance background preferred. Knowledge of medical coding (facility and professional), related medical terminology, use of medical records, billing claim forms, and federal and state regulations related to rules/coverage. Ability to investigate, analyze and resolve issues at a high level. Excellent communication, organizational and problem-solving skills.

CERTIFICATIONS/LICENSURES REQUIRED:

RHIA, RHIT, CCS, COC, or CPC, or other coding certification required or must be obtained within 12 months of hire date. Additional Information Organization: Corporate Services Department: Revenue Integrity Shift: Day Job Union Code: Not Applicable