Revenue Integrity Auditor - Business Office

Job Summary

The Revenue Integrity Auditor ensures healthcare claims are accurate, compliant, and complete by auditing coding and billing processes, reviewing patient charts, and researching variances in payer policies and internal systems to improve financial performance and prevent revenue loss. Reports and educates audit findings to appropriate team members.

Performance: Essential Functions

Decision Making: Ability to make decisions and takes appropriate action based on the information they have. Recognizes own limitations and consults with the supervisor, manager, or team member when appropriate.

Time Management: Works efficiently and manages duties to ensure that tasks are completed with accuracy and within the scheduled shift or reasonable amount of time.

Quality & Quantity: Demonstrates accurate, knowledge and skill to carry out job duties. Follows departmental work policies and procedures. Speed and consistency of output and time utilization of job duties.

Computer Knowledge & Electronic Equipment Use: Demonstrates ability to consistently utilize electronic equipment and online computer programs to perform job duties, including electronic documentation, and order entry.

Resource Utilization: Consistently utilizes and maintains supplies and equipment to minimize lost charges and unnecessary equipment repair-replacement.

Confidentiality: Adheres to established policies on privacy and security requirements for compliance with the Health Insurance Portability and Accountability Act (HIPAA), as applicable by Shannon Policy.

Performance: Position Specific Essential Functions

• Audits E&Ms for Shannon providers in accordance with the Shannon Clinic Provider Documentation and Coding Compliance Audit Plan

• Report and educate providers on audit results

• Conduct audits of billing processes

• Ensure charge capture accuracy

• Maintain regulatory compliance

• Identify revenue leakage

• Manage denial resolution

• Collaborate with appropriate team members to improve documentation and resolve coding/charge issues

• Perform other duties as assigned.