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Covenant Health · 2 months ago

REV INTEGRITY AUDITOR SR

Knoxville, TN

Full-time

Onsite

Senior Level

5+ years exp

Covenant Health is the region’s top-performing healthcare network and is seeking a Revenue Integrity Auditor Sr. This role involves performing complex internal auditing work related to compliance audits for charging, coding, documentation, and billing compliance, while also providing consulting services to management and staff.

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Responsibilities

Identifies and evaluates company risk areas and provides auditing procedures related to documentation and reimbursement. Also provides corporate oversight of any current departmental audit programs

Reviews data to identify audit issues and proactively trend data

Reviews and studies all information published by CMS and the OIG via the Federal Register, fraud alerts, OIG advisory opinions, and other publications relative to coding, billing and reimbursement compliance in order to ensure compliance

Reviews information from third party payers relative to claims charging, coding, and billing in order to ensure compliance

Explains charges and charging procedures to third party insurance companies for defense audits as applicable

Coordinates with appropriate parties the complete/ partial payment or repayment of the claims, as described in the Audit Policy, as findings are identified that are either over-payments or underpayments

Communicates or assists in communicating the results of audit and consulting projects via written reports and oral presentations to management and audit committee

Documents all audit activities in a designated location; reports statistics and identified problems monthly or more urgently if deemed necessary

Monitors audits performed at the department level in order to ensure that data is appropriate, is being maintained and is being disseminated to leadership as indicated

Assists with payor denials when necessary

Assists with special projects and performs other duties as needed and requested by the Vice President of Patient Account Services and Corporate Manager of Revenue Integrity

Works in conjunction with health information management, patient accounting, information systems and other personnel to assist with implementation of solutions to maintain a proper compliance stance

Under the direction of Revenue Integrity Manager, works with the Manager of Revenue Processes to assist with implementation of solutions to maintain a proper compliance stance

Under the direction of Revenue Integrity Manager works with the Chief Compliance Office relative to coding, billing and reimbursement compliance issues

Under the direction of Revenue Integrity Manager, works with the Chief Compliance Officer in the development and ongoing activities involved in the baseline and periodic compliance audits and compliance programs as deemed appropriate by manager

Works with contract management personnel in the review of contracts and other reimbursement or payment arrangements in relation to charging, coding and billing compliance

Advises, educates and acts as clinical/billing liaison between CFOs, department managers, providers, and billing staff to maximize reimbursement within compliance guidelines for Medicare, Medicaid and other insurance payors as deemed appropriate by manager in relation to audit findings and process improvement initiatives

Maintains lines of communications with Facilities in an ongoing effort to improve the overall quality of customer service

Promotes good public relations for the department and the Finance Division

Motivates coworkers and promotes a team effort in accomplishing goals and deadlines with accuracy, dependability and professionalism

Maintains professional growth and development through continuing education, seminars, and applicable professional affiliations to keep informed of industry trends

Demonstrates consistent aptitude in performing with minimal supervision and oversight while making independent decisions

Recognizes situations, which necessitate supervision and guidance, while seeking and obtaining appropriate resources

Independently prioritizes daily work functions/tasks ensuring all assigned deadlines are met

Coordinates with staff to ensure necessary materials, equipment and/or supplies are maintained utilizing all avenues of resource management in ordering supplies for departmental needs

Utilizes resources available appropriately, i.e. use of Covenant Health equipment and/or supplies

Does not promote or participate in solicitation during working hours within the department

Qualification

Healthcare billing knowledgeMedicare/Medicaid guidelinesHealthcare coding credentialAnalytical reviewsPublic relations skillsPC proficiencyWindows proficiencyExcel proficiencyWord processingProblem solvingCommunication skills

Required

Five (5) years' experience in health care

Good working knowledge of healthcare billing, Medicare/Medicaid billing guidelines, and other Third Party Payor rules and Regulations

Experience in problem solving, analytical reviews

Must be knowledgeable in use of PC's, Windows, Excel and Word Processing

Must have good public relations skills

Minimum of 5 years healthcare experience with background in Healthcare coding and coding credential

Must have certification (RHIT, RHIA, CCS or CPC) in field of healthcare related study or current clinical license/registration in the State of Tennessee as RN with equivalent coding experience