The Charge Auditor will be responsible for leading and performing charge capture, charge compliance and charge optimization initiatives, ensuring charges reflect services rendered. This will include collaboration with CDM, Ancillary Departments, CBO and Managed Care. The objectives will include reduction in bill holds, increase in clean claims and assurance that revenue is supported by clinical documentation. Additionally, the position will lead and respond to payer and patient audits, creating processes for both education and prevention. This will include coordinating all retrospective, concurrent, patient complaint and external billing audits, providing monthly audit results. The position will lead and coordinate with Ancillary Department and Charge Description Master team to research alternative processes in regards to charge related improvements and billing compliance issues. The Charge Auditor will develop and coordinate educational in-services for the Business Office and Ancillary staff related to charging and billing issues. The position will stay abreast of government and non-government payors to ensure facility charging is compliant and clinical documentation supports charges. Performs various QA reviews to ensure timely and appropriate charging, documentation to support charging, appropriate coding at charge level.
- Leads and performs charge capture, charge compliance and charge optimization initiatives, ensuring charges reflect services rendered. Interacts with ancillary departments to obtain additional information needed to properly bill account based on documentation in the medical record.
- Identifies charging, coding, or clinical documentation issues and works with respective departments to resolve issues and notify appropriate leadership.
- Lead and respond to payer and patient audits
- Create training program for charge reconciliation and capture
- Performs assigned audits by researching documentation, analyzing information, and makes recommendations to improve flow of claim and enters all corrections into the systems in an effort to reduce claim edits.
- Stays abreast of regulatory requirements and company compliance policies, payer requirements, significant changes and developments to ensure quality review measurements are in place at the facility.
- Performs daily QA on all surgical accounts to ensure timely and accurate charging and appropriate clinical documentation to support charging.
- Identifies and works with management to implement process improvements to lower costs and improve services to facility customers.
- Adheres to all compliance guidelines and maintains strictest confidentiality.
- Supportive of the compliance program set forth by Steward Health Care as demonstrated by:
- Upholding the Code of Conduct and Corporate Compliance.
- Adhering to and helping to enforce all compliance policies relevant to his/her area.
- Assuring timely compliance education as requested by the Regional Compliance and Safety Officer.
- Setting an example to all staff in their daily activities.
- Perform other duties as assigned by Manager and/or Director.
Required Knowledge and Skills:
- Excellent communication skills both verbal and written.
- Able to establish good customer relationships with trust and respect.
- Good interpersonal skills.
- Education: BSN preferred.
- Certification/Licensure: LPN; RN preferred.
- Experience: 5-10 years' related experience required.
- Software/Hardware: Navigation and edit resolution through various Web based systems. Ability to use email, Excel, and Word.