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Adventist Health Portland · 3 months ago

Chart Auditor (Portland)

Portland, OR

Full-time

Onsite

Mid Level

Adventist Health Portland is a leading healthcare provider in the area, offering a wide range of services since the 1800s. The Chart Auditor supports the Revenue Management Department by auditing medical records and clinical documentation to ensure accurate coding and compliance with payer standards, while collaborating with various teams to reduce clinical denials and improve documentation quality.

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Responsibilities

Conducts concurrent audits of active cases to identify documentation and order issues in real time, preventing downstream denials

Applies InterQual or Milliman/MCG criteria to validate patient status decisions and payer medical necessity compliance

Reviews medical records to validate patient placement (inpatient vs. observation) against payer criteria and physician orders

Audits clinical denials to determine root cause, trends, and opportunities for appeal, and recommends actionable prevention strategies

Performs charge audits and account reconciliations to ensure documentation is appropriate, compliant with regulations, and free of denial risk. Provides recommendations for charge corrections and technical assistance in staff training

Identifies barriers to clean claims and timely payment; tracks and trends denials, escalating systemic issues to the Director/Manager

Tracks and trends payer clinical denials, observation hours, and placement errors; prepares reports for Revenue Management leadership

Provides feedback to Coding and CDI teams regarding documentation needed for coding accuracy and DRG assignment

Partners with Case Management, Utilization Management, Medical Officer, and Physician Advisors to ensure accurate clinical documentation and timely status changes

Collaborates in payer escalations and appeal preparation by supplying clinical and documentation findings

Educates providers and staff on documentation, status order accuracy, and denial prevention strategies

Monitors CMS, state, and commercial payer regulatory changes impacting clinical documentation, placement, and observation requirements; integrates updates into audit practices

Demonstrates reliability, responsiveness, and effective follow-up on matters requiring attention

Performs other job-related duties as assigned