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Adventist Health · 16 hours ago

Sr. Revenue Cycle Compliance Auditor

Roseville, CA

Full-time

Onsite

Senior Level

5+ years exp

Adventist Health is a faith-based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii. The Sr. Revenue Cycle Compliance Auditor works independently to perform program, compliance, and risk-based reviews of healthcare-related activities, ensuring accuracy in medical record documentation, coding, and billing policies.

Elder CareHealth CareHospitalMedicalNon ProfitWellness

Responsibilities

Performs comprehensive reviews of health care records for accuracy of revenue cycle billing compliance to include but not limited to medical necessity, compliance risk, review of denials, charge trends, and applied CPT, HCPCS, ICD 10-CM and ICD-10-PCS coding guidelines for inpatient, outpatient, and/or clinic visit encounters that correlates to clinical documentation. Performs a variety of activities in support of internal audits and coordinates external audits including Recovery Auditor Contractors’ (RAC), Livanta, Target Probe and Educate (TPE) and Attorney Client Privilege Audits

Produces comprehensive audit finding reports that include quantifiable impact, identify areas of opportunity for education, as well as improvement recommendations. Ensures timely dissemination of external audits; generates timely appeals and adheres to all deadlines. Generates RAC reports including but not limited to dollars at risk; Tracks and trends and provides education to coding, operations, and Physicians as needed

Communicates clearly (verbally and in written reports or summaries) opportunities regarding proper clinical documentation guidelines, service selection, charge capture and timely submission, healthcare data accuracy and coding principles. Leads and facilitates multi-disciplinary workgroups or projects. Ability to be a project lead to facilitate through all successful action outcomes. Mentors, coaches, and helps to provide on-job training for staff

Participates in improving the efficient and effective delivery of the Department's services including promoting the department brand, complying with department and professional standards, participating in department initiatives and internal process improvement projects, and providing input into the enhancement of audit methodologies, workflows and tools

Generates audits, utilizing Auditing platform for denials, coding reviews and other risk-based data for department audits. Reviews, researches, references state and federal regulations, payer program memorandum, and other complex, technical and/or legal documents. Participates in annual risk assessment and work plan development processes

Performs other job-related duties as assigned

Qualification

Healthcare codingAuditing experienceCertified Coding SpecialistRevenue cycle complianceEducational trainingCommunication skillsProject management

Required

Associate's/Technical Degree or equivalent combination of education/related experience

Five years' experience in healthcare coding inpatient, outpatient, rural health care and/or professional fee services

Certified Coding Specialist (CCS) or Certified Coding Specialist – Physician (CCS-Phy) or Certified Professional Coder (CPC) or Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT)

Preferred

Bachelor's Degree

Five years' experience in auditing in clinic and/or facility revenue cycle

Professional Medical Auditor (CPMA) or Certified E&M Coder (CEMC) or Certified E&M Auditor (CEMA) or Certified Documentation Integrity Practitioner (CDIP) or Certified Clinical Documentation Specialist- (CCDS) or CIRCC-AAPC or Radiation Oncology Certified Coder (ROCC)