Clinical Charge Auditor
The purpose of this position is to evaluate charges and documentation and provide the client with information to improve charge and documentation compliance.
Resolve issues within the billing process to achieve charge compliance. Conduct all audits in a professional, ethical manner in accordance with the National Hospital Billing Audit Guidelines based on findings in the clinical documentation and represents the best interest of the client when possible. Demonstrate accurate analysis and interpretation of clinical information. Assist the MRI audit team to fulfill contractual obligations with one or more facilities.
Perform charge audits, defense audits, documentation compliance audits and pre/post EMR implementation audits depending upon the clients’ requests and contract. Conduct all audits in a professional, ethical manner in accordance with the National Hospital Billing Audit Guidelines based on findings in the clinical documentation and represents the best interest of the client when possible.Â
Use resources including communication with MRI nurses and coders, healthcare facility staff, CMS regulations, CPT codes, medical record documents, journal articles and health system policies to determine appropriateness of charges. For defense audits, prepare correspondence to insurance auditor including evidence of findings in the medical record, health facility policy and procedure, and /or research from medical literature and regulations to support the care that was provided and charged. Schedule appointments and follows up with payer auditors to evaluate findings and determine adjustments, if any. Follow departmental guidelines and client- established parameters when conducting audits. Ensure that audits are completed in a timely manner and documented in a clear and concise manner on MRI and client forms. Assure that medical interpretation and decision making is appropriate for all defense, charge, and documentation compliance audits. Document audit findings on spreadsheets or data base. Track accounts on hold when questions or documentation issues prevent immediate completion of the audit. Respond to management requests to review patients’ medical record and interpret clinical information as requested.
Participate in hospital meetings to report audit findings and suggest improvements. Provide information, education, and feedback to hospital staff to improve revenue recovery and compliance as requested. Communicate and interact effectively with project principals, MRI management and hospital liaisons. Uses technology including word-processing and spreadsheet applications as required to complete audits and reports.Â
Provide help to coworkers as needed to promote the success of the team. Mentor newly hired auditors as requested. Participate in Clinical Charge Audit meetings and MRI employees’ meetings. Attend Continuing Education related to the nurse audit position at least annually. Certification in auditing is desirable. The Clinical Charge Auditor will review clinical documentation and compare it to account billing documents to determine if charges are supported for concurrent or retrospective charge audits, defense audits and compliance audits. The Clinical Charge Auditor uses clinical decision-making based on medical and nursing knowledge of patient care, procedures, medications and supplies to compare charges with documentation in the medical record. The nurse auditor uses knowledge of healthcare financial guidance including statutory regulations, the charge master, client charge policies and patient care policies of the Health System to promote optimization of revenue recovery as well as compliance in the billing process.
Ideal candidate will possess the following:
• Broad clinical knowledge to review medical records to determine if charges are supported and if charges should be added or deleted from the bill.
• Working knowledge of CMS regulations, chargemaster, CPT codes, current rules in applying charges and electronic medical record programs.
• Graduate of an accredited College, University or Nursing Program.
• Current and Active Registered Nurse licensure required in the State where the client is based.
• Minimum of 3-5 years of clinical experience in an Acute Care Hospital.
• Knowledge of the Revenue Cycle and hospital billing requirements including UB-04, revenue codes, itemization of charges, CPT codes, and HCPCs codes.
• Ability to travel to perform onsite client projects as identified; travel may be required 10 to 20% of the time.
• Certification in auditing is preferred
• Experience in working with Electronic Medical Records, i.e., Cerner, EPIC, Medi-Tech. Must possess strong math skills and ability to work with numbers.
• Ability to work in Microsoft office and Excel.
• Excellent organizational skills with a strong focus on detail.
• Excellent verbal and written communication skills.
• Ability to work independently.
• Ability to organize, plan, prioritize, and complete assignments within the required time frame.
• Responsible for preparing clear, concise, and legible audit reports. Tools & equipment: Computer, printer, copier, telephone, fax machine, file folders, filing cabinets. Working Environment: Normal business office conditions or remote work from home.
Managed Resources, Inc. Equal Opportunity Employer (EOE) M/F/D/V/SO
