SUMMARY:
The Revenue Cycle Auditor reviews medical records and billing information before and after payments and denials to ensure accurate charges and proper billing. They help resolve billing and coding issues, support audits, and educate staff in billing practices.
ESSENTIAL FUNCTIONS:
• Audit claims and medical records using tools like Revenue Guardian and billing software. • Help resolve billing and coding issues, including denials. • Support internal and external audits and special projects. • Develop and update policies related to billing and revenue. • Monitor industry trends and advise on potential impacts. • Educate staff and managers on billing and revenue topics. • Ensure compliance with state and federal regulations. • Assist with staff training and development. • Work closely with billing and clinical teams to improve practices. • Follow all safety, confidentiality, and organizational policies. • Perform other related duties as needed.
MINIMUM QUALIFICATIONS:
EDUCATION:
High school diploma or GED required; vocational training in medical office administration preferred.
EXPERIENCE:
Three (3) years' experience performing hospital business office billing, coding, or reimbursement.
LICENSURE OR CERTIFICATION:
Certified Revenue Cycle Representative (CRCR) through Healthcare Financial Management Association (HFMA) within one (1) year of hire.
KNOWLEDGE, SKILLS, AND ABILITIES:
• Thorough knowledge of ICD and CPT application, correct practices, and tools utilized within the hospital or healthcare industry is required. • Knowledge of computer application software such as Microsoft Office products. • Skill in the developing procedures and training material. • Skill with HIM, billing systems, denials, and financial analysis. • Ability to read and interpret documents, medical records, and related legislation.