Compliance & Charge Capture Auditor

Responsible for auditing accounts prior to billing according to coding, regulatory, and payor policy guidelines. Addresses debit and credit charging errors to assure correct final bills. Audits documentation to make sure the chart documentation matches the charges on the patient account. Tracks and analyzes data trends, reporting those trends back to clinical directors and providing additional education to clinical staff where appropriate. Performs daily audits on all Inpatient and Observation accounts. Responsible for quarterly focused audits of areas with suspected or confirmed problems.ResponsibilitiesPerform daily audits of all Inpatient, Observation, ED and Outpatient Infusion via WQ monitoring, review of department revenue variance, and collaboration with operational areas. For Observation accounts, auditor is responsible for analyzing number of hours charged and whether all are appropriate according to regulation. If not, auditor must credit the appropriate number of hours. In partnership with Revenue Integrity leadership, plans, coordinates, and conduct audits/ internal control evaluations and reviews as scheduled. Presents project results to leadership team. Responsible for tracking and trending charge anomalies Maintains knowledge of clinical documentation standards and charge related regulations and standards. Applies knowledge to ensure that charges are accurate and supportable according to payer and regulatory requirements. Responsible for ad hoc training/retraining of clinical staff if director asks. Responsible for printing daily IP and OBS census and analyzing documentations to make sure correct charges are entered.I f there is documentation, but no charge, auditor is responsible for adding appropriate charge to account. If there is a charge, but no documentation, auditor is responsible to contact the department director or manager and ask if charge is appropriate, and if so ask if the nurse can still document. For Observation accounts, auditor is responsible to add all IV infusion and injection charges according to CMS guidelines. Plan, coordinate and conduct audits, internal control evaluations and reviews as scheduled. Prepare neat, well organized and documented work papers, reports or memorandums. Responsible for processing all bills received for clinical services obtained from an outside company. Auditor must communicate with the clinical dept. director ordering that test to obtain authorization to pay the bill and interface with Finance and Revenue Cycle to get the bill paid. Manages large complex projects, investigates and analyzes issues at a high level with strong attention to detail. Completes and/or attends training and education sessions as assigned by leadership.QualificationsCertifications: Certified Professional Coder - Apprentice (CPC-A) within 1 year - American Academy of Professional Coders (AAPC); Certified Coding Associate (CCA) within 1 year - American Health Information Management Association (AHIMA); Registered Health Information Technician (RHIT) within 1 year - American Health Information Management Association (AHIMA); Epic Certification within 18 months - EPIC; Certified Professional Coder - Hospital (CPCH) within 1 year - American Academy of Professional Coders (AAPC); Certified Coding Specialist (CCS)within 1 year - American Health Information Management Association (AHIMA); Registered Health Information Administrator (RHIA) within 1 year - American Health Information Management Association (AHIMA),

Created: 2025-05-09