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Stanford Health Care · 1 month ago

Revenue Integrity Charge Auditor (Remote)

United States

Full-time

Remote

Mid Level

$52.69/hr - $69.82/hr

3+ years exp

Stanford Health Care is seeking a Revenue Integrity Charge Auditor who will perform auditing activities related to regulatory compliance and billing accuracy. The role involves conducting audits, collaborating with teams to optimize billing practices, and preparing reports on findings to ensure adherence to federal and state regulations.

Health CareHealth DiagnosticsHospitalMedicalPrimary and Urgent Care

Comp. & Benefits

H1B Sponsor Likely

Responsibilities

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, underbilled, 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

Qualification

ICD-10-CM codingCPT codingMedicare billing practicesEpic EMRCharge capture workflowsDRG/APC reimbursementHealth information systemsCommercial payer reimbursementEffective communicationProblem-solvingTeam collaborationTime managementDecision making

Required

Bachelor's degree in a work-related discipline/field 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 and MediCal

Working knowledge of commercial payer reimbursement models

Knowledge of Medicare billing practices

Proficient EXCEL, WORD, PowerPoint skills

RN - Registered Nurse - State Licensure And/Or Compact State Licensure required . or

CCS - Certified Coding Specialist required . or

CPC and/or CCSP - Certified Professional Coder required . or

Certified Outpatient Coder - COC required . and

CPC required . or

RHIT - Registered Health Information Technician required . or

RHIA - Registered Health Information Administrator required

Company

Stanford Health Care

Glassdoor4.0

Stanford Health Care is a healthcare center that treats cancer, heart disease, brain disorders, and primary care issues.

Founded in 1885

Palo Alto, California, USA

10001+ employees

https://stanfordhealthcare.org

H1B Sponsorship

Stanford Health Care has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (102)

2024 (74)

2023 (82)

2022 (55)

2021 (54)

2020 (67)