Revenue Integrity Auditor - Revenue Integrity

UCI Health is one of California's largest academic health systems and the clinical enterprise of the University of California, Irvine. Established on July 1, 1976, UCI Health has grown into a 1,461-bed health system that includes UCI Health
- Orange, UCI Health
- Irvine, four Community Network hospitals and a growing network of ambulatory care centers across Orange and Los Angeles counties. As Orange County’s only academic health systems, UCI Health is home to the only National Cancer Institute-designated comprehensive cancer center based in the county, the region’s only American College of Surgeons-verified Level I adult and Level II pediatric trauma center, American College of Emergency Physicians Gold Level 1 Geriatric Emergency Department and a nationally recognized regional burn center verified by the American Burn Association.

Powered by UC Irvine, UCI Health serves 5.6 million people across Orange County, western Riverside County and southeast Los Angeles County through excellence in patient care, research and medical education.

Position Summary:

The incumbent is responsible for performing comprehensive Revenue Cycle audit reviews, which include identifying areas of risk, determination of regulatory and compliance risk, and ongoing audit necessity, as well as determining denial prevention opportunities. This position will focus on evaluating the adequacy and effectiveness of internal and operational controls to ensure that all regulatory and billing compliance guidelines are being met in accordance with hospital and professional billing standards.

Audit reviews will include hospital and professional medical record documentation, charge data, coding data, and denial trends, to assess risks and determine potential impacts. The candidate should have extensive knowledge of medical terminology and hold a coding certification, along with experience working with various health plan products such as Medicare, Medi-Cal, HMO, PPO, and Managed Care, as well as private insurance and CMS guidelines.

Previous experience in a hospital setting, particularly with split fee billing and a focus on hospital billing, is preferred. This role involves preparing comprehensive audit reports that quantify impacts on both gross and net revenue, identifying opportunities for educational initiatives, and implementing the corrective measures for process improvements.

• Proficient EXCEL, WORD, PowerPoint skills
• Must possess the skill, knowledge and ability essential to the successful performance of assigned duties
• Must possess multiple current Coding Certifications (i.e., CPC, COC, or AHIMA equivalent)
• Must possess experience reviewing and interpreting CMS, Commercial and Government payer coding and payment requirements.
• Must possess a current Coding Certification (CPC, COC, or AHIMA equivalent)
• Must demonstrate customer service skills appropriate to the job
• Knowledge of health information systems for computer application to medical records
• Knowledge of ICD-10-CM & CPT coding conventions to code medical record entries; abstract information from medical records; read medical record notes and reports; set accurate Diagnostic Related Groups
• Knowledge of DRG/APC reimbursement
• Five years’ experience in hospital and physician billing, charging practices.
• Five years’ auditing experience working in acute care hospital and academic institution
• Familiarity of audit software packages
• Experience in providing both verbal and written feedback or education directly to clinical and/or billing staff regarding coding, charging, documentation, payor authorization, and claim processing requirements.
• Excellent written and verbal communication skills in English
• A…