Indianapolis, Indiana
Revenue Cycle Support, Charge & Operations Auditor Job Opening in Indianapolis, Indiana - This position is responsible for pre and post payment claim auditing of medical records and associated clinical documentation to ensure proper charge capture, billing in accordance with standard billing policies and reimbursement principles. This position is responsible for assisting Revenue Cycle Services, HIM, and other departments with resolution of billing issues and / or denials requiring clinical expertise, participating in external audit requests, and special projects as needed. This position also serves as an audit outcome educator with clinical staff in clinic and department settings.
ESSENTIAL JOB FUNCTIONS:
Coordinates, conducts, and documents full or partial chart-to-bill audits for:
existing services to ensure revenue capture and documentation accuracy
newly implemented hospital services
defense audits requested by payers or outside agencies
cost outlier and high balance accounts prior to billing or post third party vendor review
other audits as assigned by management
prepares written reports or trending data related to findings and facilitates sign off with leadership
facilitates timely turnaround of audit results
prepares written summaries of departmental audit results, which allow clinical leadership the ability to monitor and manage their revenue capture and documentation processes
Keeps Revenue Integrity Manager informed on various findings and communications with areas assigned for audit and/or process review
notifies Charge Reconciliation, CDM, and Revenue Cycle Education Staff of pertinent audit issues requiring their intervention to remedy / correct * Works cooperatively within Revenue Cycle Support, and Clinic / Department Staff to update charge tickets on an as needed basis and according to department standards.
ensures updated charge tickets are appropriately posted to Eskenazi Health E-Hub Portal * Requests appropriate CDM additions / modifications through the Craneware Workflow Tool
Develops and maintains a highly effective working relationship with Corporate Compliance, Finance, HIM, Revenue Cycle Services, Transition Support, and various clinic / department staff and their leadership
Provides education to clinical staff and clinic / department leadership on the appropriate utilization of charge tickets and suggests documentation improvements where appropriate
Identifies inappropriate billing patterns in accordance with hospital charging protocols and industry standards. Makes recommendations for improvement of procedures, documentation, and revenue optimization opportunities
Works diligently to attain appropriate Revenue Integrity goals
Researches and resolves STAR Receivables Workstation (RWS) billing, payor, and customer service related issues in a timely and compliant manner
Retrieves and validates patient account information and charge related documentation from multiple information systems and / or from hospital department personnel
Resolves National Correct Coding Initiative (NCCI) Edits, Correct Coding Initiative (CCI) Edits, and Medically Unlikely Edits (MUE)
Recommends and / or applies appropriate modifiers in support of medical services rendered
Researches and corrects Room and Observation Hour issues
Ensures patient satisfaction by resolving charge related issues routed from Customer Service inquiries
Resolves charge issues associated with credit balance accounts
Enters account corrections and detailed comments in McKesson STAR to ensure a clear line of communication
Researches, works proactively with charging departments, and resolves billing and / or charging issues Resolves PreBill (PBE) Errors in the Room/Unit category
QUALIFICATIONS:
Medical Technician, LPN, RN, with current state licensure OR certified R.H.I.A., R.H.I.T., CCS, CCS-P, CPC, CPC-H, CCA, OR Associate?s degree required. Bachelor?s degree preferred.
Experience with Health Information Management (HIM), Facility/Physician Billing, Charge Description Master (CDM), Denials Management, Charge Integrity, Financial Analysis
Minimum of three years experience in hospital or physician setting with extensive Revenue Cycle knowledge
Minimum of two years of hospital audit experience with a concentration in High Balance and Cost Outlier and/or facility based clinic audits
ORGANIZATIONAL OVERVIEW:
A competitive compensation and benefits package is offered, and includes:
Health, dental and vision insurance
Paid time off
Life insurance
Tuition reimbursement
Employer matching retirement plan
Free fitness center and wellness program
Enjoying your job makes smiling easy. At Eskenazi Health, we care about our employees and want them to have the best experience possible while on the job. Eskenazi Health is always looking for quality professionals to fill positions in the organization.
Eskenazi Health is one of America's largest essential health systems. Our mission is to Advocate, Care, Teach and Serve, with special emphasis on the vulnerable populations of Marion County, Indiana. Our academic health system provides a comprehensive range of primary and specialty care services within our 315-bed hospital and inpatient facilities as well as 11 community health centers located throughout Indianapolis. We put our patients first, and we provide excellent quality care indiscriminately and without consideration of financial factors.
Eskenazi Health's main campus achieved Leadership in Energy and Environmental Design (LEEDŽ) Gold certification in 2015. This designation made the campus among the first and largest new hospital campuses in the United States and first in the state to achieve this recognition. The Eskenazi Health campus is innovative with green spaces, an urban garden, art displays, and abundant gathering spaces that enhance collaborative work and creativity.
Job Type: Full-time
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