Description
Revenue Integrity
Perform advanced revenue cycle auditing and analysis to support accurate billing, regulatory compliance, and optimal reimbursement across hospital and professional services claims. As the Revenue Integrity QC Auditor, you will conduct pre-billing and retrospective claim audits, evaluate coding, charging, billing, denial, and reimbursement activity, and identify financial risks, root causes, and revenue recovery opportunities. This role collaborates with clinical, operational, coding, compliance, information technology, and revenue cycle partners to strengthen charge capture, claims performance, billing accuracy, and revenue integrity practices.
In this role, you will:
• Conduct pre-billing, concurrent, and retrospective audits of hospital and professional claims to evaluate coding, charging, billing, reimbursement accuracy, and regulatory compliance.
• Review claims and medical record documentation to identify billing errors, charge discrepancies, payment variances, denials, compliance risks, and opportunities for revenue recovery.
• Apply CPT, HCPCS, ICD-10-CM, and ICD-10-PCS coding principles and payer requirements when evaluating government, managed care, and commercial claims.
• Analyze denials, rejections, stop bills, discharged-not-final-billed accounts, underpayments, and overpayments to identify root causes and recommend corrective actions.
• Analyze revenue cycle, claims, denial, reimbursement, and operational data and develop audit findings, reports, dashboards, scorecards, quality control metrics, and recommendations for leadership.
• Collaborate with Revenue Integrity, Coding, Patient Business Services, Compliance, Information Technology, and clinical departments to resolve billing and reimbursement issues and support corrective action plans.
• Provide guidance and education on coding, charging, billing, documentation, reimbursement requirements, audit processes, and revenue cycle best practices.
• Support process improvement efforts focused on charge integrity, workflow effectiveness, revenue recovery, compliance, and reduction of revenue loss.
Salary Range:
$88,900 to $190,300 annually
