Revenue Integrity Charge Auditor; Remote

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Day - 08 Hour (United States of America)

This is a Stanford Health Care job.

The Charge Auditor performs auditing activities, including complex cases that require extensive research, interpretation and application of laws and regulations. Charge Auditor evaluates the adequacy and effectiveness of internal and operational controls designed to ensure that processes and practices lead to appropriate execution of regulatory requirements and guidelines related to professional or facility and documentation, charging, coding and billing, including federal and state regulations and guidelines, CMS (Centers for Medicare and Medicaid Services) and OIG (Office of Inspector General) compliance standards.

Stanford Health Care

• Conducts defensive charge audits, self-pay/patient requests, or other special audit projects, as requested, comparing itemized bills to corresponding medical records and identifying documented services unbilled and charges for services not documented that need to need to be removed from an account

• Conducts audits for Medicare/Medicaid Cost Outlier accounts prior to billing, ensuring itemized bill is accurate.

• Conducts retrospective audits as requested.

• Collaborates with RI CDM to optimize the integrity of the Chargemaster

• Applies consistent and standardized compliance monitoring methodology for sample selection, scoring and benchmarking, development and reporting of findings.

• Prepares written reports of review findings and recommendations and presents to management and maintains monitoring records.

• Researches, abstracts and communicates federal, state, and payor documentation, and billing rules and regulations; stays current with Medicare, Medi-Cal and other third party rules and regulations including ICD-10 and CPT code updates.

• Performs defense auditing of targeted medical records in conjunction with the itemized bills for charging error, substandard documentation and inaccurate procedural billing.

• Performs concurrent review of hospital bills to document non-billed, under billed, and overbilled items/services.

• Utilizes charge documents as required by Health System to reconcile charges to items/services documented in the medical record.

• Prepare reports by management regarding audit results, process improvement recommendations and systemic billing errors.

• Make monthly observations and recommendations to prevent future reimbursement losses.

• Bachelor’s degree in a work-related discipline/field required. Required

• Three (3) years of progressively responsible and directly related work experience Required

• Ability to analyze and develop solutions to complex problems

• Ability to communicate effectively in written and verbal formats including summarizing data, presenting results

• Ability to comply with the American Health Information Management Associate's Code of Ethic and Standards and applicable Uniform Hospital Discharge Data Set (UHDDS) standards

• Ability to establish and maintain effective working relationships

• Ability to judgment and make informed decisions

• Ability to manage, organize, prioritize, multi-task and adapt to changing priorities

• Ability to use computer to accomplish data input, manipulation and output

• Ability to work effectively both as a team player and leader

• Knowledge of Epic EMR and billing

• Knowledge of charge capture workflows and CDM

• Knowledge of DRG/APC reimbursement

• 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 standards and regulations pertaining to the maintenance of patient medical records; medical records coding systems; medical terminology; anatomy and physiology and study of diseases

• Knowledge of governmental payment practices for Medicare…