Job Description
Overview
Monday through Friday 8:00 AM TO 5:00 PM
The Charge Audit Specialist has responsibility to perform charge capture audits, initiate and lead performance improvement efforts to enhance charge capture, educate clinical departments and promote revenue cycle integrity.
Responsibilities
- Perform charge capture audits by comparing the medical record documentation against the itemized bill.
- Identify charging, coding or clinical documentation issues and work with ancillary departments to resolve issues and notify appropriate leadership.
- Prepare modifications to patient charges as a result of the audits and as required to ensure appropriate revenue integrity.
- Respond to RAC and other third-party payer audit requests in collaboration with Health Information Management and Patient Financial Services.
- Maintain an audit activity report to track and communicate audit activity with the associated financial impact. Analyze audit results to identify patterns, trends, variances and opportunities to improve revenue integrity.
- Initiate and lead performance improvement efforts through multi-disciplinary teams to streamline processes, enhance charge capture and promote revenue cycle integrity.
- Provide education to all clinical departments as needed to promote appropriate charge capture processes and improve understanding of the documentation requirements for specific charge activity.
- Function as a resource to the CDM Coordinator when clinical information is needed to appropriately maintain the Charge Description Master.
- Analyze and resolve patient claims being held by billing edits (i.e. NCCI/modifier 59, Medical necessity, Correct coding Initiative, Outpatient Code Editor (OCE), Inpatient Code Editor, Self-Administered and other claims requiring clinical expertise’s).
- Compare UB04 charges to BAR charges and ensure all discrepancies are appropriate.
- Performs all other duties as assigned by management within job scope.
Qualifications
Education / Training
- High School Diploma/Equivalent
Experience
Preferences:
3-4 years of experience; charge audit or finance related experience. Experience in coding and /or reimbursement.
Certificates/Licenses/Registration
- Active coding certification from AAPC or AHIMA
Preferences:
Certified Professional Coder (CPC)
Additional Information:
Certified Professional Coder (CPC) required within 1 year of hire.
