Revenue Integrity Auditor - Physician Billing; PB

Position Summary

• Perform Charge Capture Reconciliation Audits for all hospitals with the ECU Health System to ensure compliance of Health System Departmental Charge Capture and Reconciliation Policy.
• Report findings via a monthly Revenue Integrity Audit Scorecard for each facility audited and assist Revenue Integrity Leadership in facilitating monthly meetings to discuss findings with each area audited.
• Assist Departmental Leadership in the development of corrective action plans and training for non-compliant areas and re-audit to ensure improvement plans and training have improved charge reconciliation compliance rates.
• Maintain expertise on Third Party Billing Regulations and Requirements to ensure Epic EAP/CDM remains in compliance with applicable regulations for ECU Health entities.
• Develop tools to provide education and communication to Revenue Producing Departments.
• Analyze reimbursement and charge data for service line analysis and other special projects as needed.
• Develop and maintain understanding of systems involved in the updating of charges as well as PC related skills.

• Ensure compliance of the ECU Health Charge Capture Reconciliation Policy is upheld by each revenue generating department across the system.
• Lead, develop and facilitate a robust audit program that continuously monitors the usage of charge reconciliation reports and charge review work queues.
• Maintain facility specific scorecards to include corrective action plans for non-compliant departments as well as recognition of departments and individuals who are meeting or exceeding their reconciliation and work queue expectations.
• Escalate non-compliant departments to designated Leadership and work with appointed individuals to ensure corrective action plans and/or training are being administered and improvement in compliance rates have been achieved.
• Work with Revenue Integrity leadership to conduct a monthly Revenue Integrity Audit Scorecard Read‑Out to each facility's leadership.
• Share monthly audit results and corrective action plans with finance and clinical leadership.
• Remain up-to-date on Third Party Billing Regulations by reviewing regulatory/contractual updates and communications. Must be able to utilize this information in the decision making process of implementing accurate and compliant charge capture. Charges that are not accurate or compliant can cause billing errors and result in a payback or in the cases of investigative audits by the OIG or other agencies, financial damages.
• Answer all questions regarding the appropriateness of charging for services and products. Must be able to function independently. Communication on charging issues must be provided in a professional and customer service oriented manner.
• Keep up-to-date on EPIC or other related EAP software functionality. Should be able to understand the hospital billing system processes and related clinical systems so charges are correctly updated in all systems. Must be able to use Excel or other necessary software to manipulate, summarize, and analyze data.

• Bachelor's Degree preferred.
• 3 – 4 years of experience required.
• RHIA/RHIT certification preferred.
• Knowledge, Skills & Abilities required: (i.e., supervision, computers, etc.).
• Physician Billing Charging and/or Coding Experience is preferred.
• Demonstrated ability to manage, teach, make independent decisions and assume responsibility.
• Strong interpersonal communication skills, verbal and written.
• Ability to communicate and work effectively with all levels of staff.
• Working knowledge and experience with PC-based applications, i.e., Word, Excel, PowerPoint, Outlook.
• Ability to function as a leader, team member and execute the desired outcomes.
• Must exhibit creative, positive problem‑solving abilities.
• Ability to foster collaboration between multiple parties.
• Ability to plan, organize and effectively present ideas and concepts to groups.
• Ability to think conceptually and apply concepts in a practical application.
• Ability to assimilate information from a variety of sources, analyze information, and determine a course of action.
• Ability to consider diverse opinions and incorporate them into the…