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Revenue Integrity Auditor

Methodist Health System locationOmaha, NE
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482 positions
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Web Mktg Technology Specialist

Methodist Health System locationOmaha, NE
482 positions
info linkReport a probelm Originally Posted : April 19, 2021 | Expires : June 18, 2021

Details

Salary
Unspecified
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Job Location
Omaha, NE, United States

Description

  • Purpose of Job
    • The Revenue Integrity Auditor is responsible for coordinating and facilitating clinical review functions for all entities to ensure all appropriate billable charges are captured as documented within the patient record.
      • Reviews medical documentation and compares to posted charges to determine whether services charged are supported by the medical record.
      • Serves as a liaison between Finance, Charge Services, Health Information Management (HIM) and other departments.
      • During the course of a review the Auditor will educate clinical staff and department leaders of missed charges, late charges, or incomplete documentation which doesn't support billed charges.
      • May assist in external insurance audits or special projects as needed.
  • Job Requirements
    • Education
      • Associates or Bachelors Degree in business, healthcare administration, or related area required.
      • Bachelors of Nursing (BSN) preferred.

    • Experience
      • Demonstrated knowledge of clinical documentation processes and procedures.
      • Minimum 5 years experience working in a hospital setting with significant exposure to orders/charge processes and electronic medical records (EMR).

    • License/Certifications
      • Current valid Nebraska Registered Nurse (RN) License, valid compact multistate license to work in Nebraska, or a temporary permit while awaiting licensure required.

    • Skills/Knowledge/Abilities
      • Knowledge of Medicare Severity-Diagnosis Related Group (MS-DRG), All Patient Refined-Diagnosis Related Group (APR-DRGs), Medicare Ambulatory Payment Classification (APC), Enhanced Ambulatory Patient Grouping (EAPG).
      • Excellent time management and attention to detail skills.
      • Excellent written and oral communication skills.
      • Self-starter with ability to work with minimal oversight.
      • Ability to effectively work in a team environment.
      • Strong independent problem-solving skills using critical thinking, logic and reasoning to assess and resolve problems.
      • Excellent computer skills, including proficiency in Microsoft Office Suite.
  • Physical Requirements
    • Weight Demands
      • Light Work - Exerting up to 20 pounds of force.

    • Physical Activity
      • Not neccessary for the position (0%):
        • Climbing
        • Crawling
        • Kneeling
      • Occasionally Performed (1%-33%):
        • Balancing
        • Carrying
        • Crouching
        • Distinguish colors
        • Grasping
        • Lifting
        • Pulling/Pushing
        • Standing
        • Stooping/bending
        • Twisting
        • Walking
      • Frequently Performed (34%-66%):
        • Fingering/Touching
        • Keyboarding/typing
        • Reaching
        • Repetitive Motions
        • Sitting
        • Speaking/talking
      • Constantly Performed (67%-100%):
        • Hearing
        • Seeing/Visual

    • Job Hazards
      • Not Related:
        • Chemical agents (Toxic, Corrosive, Flammable, Latex)
        • Biological agents (primary air born and blood born viruses) (Jobs with Patient contact) (BBF)
        • Physical hazards (noise, temperature, lighting, wet floors, outdoors, sharps) (more than ordinary office environment)
        • Equipment/Machinery/Tools
        • Explosives (pressurized gas)
        • Electrical Shock/Static
        • Radiation Alpha, Beta and Gamma (particles such as X-ray, Cat Scan, Gamma Knife, etc)
        • Radiation Non-Ionizing (Ultraviolet, visible light, infrared and microwaves that causes injuries to tissue or thermal or photochemical means)
        • Mechanical moving parts/vibrations
  • Essential Job Functions
    • Essential Functions I
       

      • Performs pre- and post-payment charge audits to identify potential lost revenue opportunities.

      • Provides education to clinical staff and department managers for effective charge capture.

      • Identifies opportunities for missed charges and inappropriate billing patterns in accordance with hospital charging protocols and industry standards.

      • Develops and maintains an effective working relationship with Charge Services, Clinical coding, clinical staff, and department managers to improve processes.

      • Performs Charge audits and prepares reports to identify missed revenue opportunities for the corporate compliance program.

      • Works with clinical departments to ensure audit findings are addressed and assist with best practices for charge/order entry moving forward.

      • Analyzes root causes for duplicate, missing, late charges, or incorrectly charged services and items and provide education as needed.

      • Keeps abreast of CMS and other federal regulations concerning charge capture.

      • Keeps Reimbursement Supervisor informed of audit findings and communicates findings with clinical staff and department management team.

      • Addresses HIM/Coding staff questions regarding charge issues as needed.

    • Essential Functions II
       

      • Participates in mandatory in-services and/or CE programs as mandated by policies and procedures/external agencies and as directed by management.

      • Follows and understands the mission, vision, core values, Employee Standards of Behavior and company policies/procedures.

      • Other duties as assigned.








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Methodist Health System

Health Care/Wellness/Fitness
482 active jobs
locationFremont, NE
clockFull-time
locationOmaha, NE
clockFull-time
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