Job Abstract

Requisition ID

2024-16094

Category

Corporate and Support Services

Status

Full Time

The Revenue Integrity Auditor is responsible for auditing complete, correct, timely and compliant charge capture initiatives and processes in the organization including in the Electronic Health Record. The Revenue Integrity Auditor is responsible for reviewing and interpreting managed care contracts, government fee schedules and regulations to ensure appropriate reimbursement and documentation standards. The Revenue Integrity Auditor ensures that all departments and programs in Bancroft are in compliance with regulatory documentation and coding standards.

1. Conducts audits and reviews activities to improve revenue cycle, claims production, and coding integrity.
2. Reviews modifiers to determine if accurate following Medicare and National Correct Coding Initiative (NCCI).
3. Review medical records to determine if facility coding is accurate.
4. Reviews data and systems to target areas of improvement.
5. Serves as a subject matter expert and in a consultative role to various stakeholders.
6. Works collaboratively with stakeholders.
7. Maintains knowledge of and organizational compliance with state, federal, and other third-party payer billing and reimbursement guidelines.
8. Assist management in examining processes to improve workflow.
9. Reviews and monitors billing and coding changes affecting charge capture processes in accordance with payer requirements.
10. Provides guidance and education to billing and clinical department staff related to appropriate documentation requirements, denials resolution, and regulatory requirements relevant to charging, coding, and billing.
11. Compiles and analyzes data from various sources to develop recommendations leading to potential revenue cycle opportunities including, but not limited to, analyses related to CDM set-up, charge capture, billing, and patient financial services as a function or result of audits.
12. Conducts root-cause analyses to identify opportunities for error reduction.
13. Implements charge capture corrective measures and monitoring tools to ensure sustainability of changes; performs, reviews, and monitors statistics and key performance indicators to identify improvement opportunities.
14. Identifies documentation risk areas and develops formal audit reports.
15. Reviews the compliance work plan and makes recommendations including, but not limited to, frequency of audits, annual risk assessments, and audit findings.
16. Prepares summary reports for the Executive Compliance Committee and the Board Compliance, Audit, and Enterprise Risk Committee as needed.
17. Supports the organizational leadership by developing coding and documentation educational and training programs to comply with applicable federal and state laws.
18. Demonstrates the highest level of confidentiality and conducts themselves according to AHIMA Code of Ethics.
19. Abides by the Bancroft’s Mission Statement, Vision Statement, Core Values, Philosophy of Care and Code of Ethics in promoting behavioral norms, establishing relationships and providing guidance in decision-making situations.
20. Remains current with required training certifications, meets state-regulated licensing and regulatory accreditations, and adheres to mandatory requirements.
21. Performs other duties as assigned.

Education & Experience:

Bachelor’s degree from an accredited college in accounting, finance, or healthcare administration. Equivalent and relevant combination of education and experience may be considered in lieu of a Bachelor's degree. Minimum of five years of revenue cycle management and/or revenue integrity experience in a healthcare environment. Working with people with intellectual/developmental disabilities and/or audit experience in healthcare is highly desirable.

Special Skills:

Effective written and verbal communication skills required, as well as effective interpersonal, organization, and time management skills. Ability to operate independently, work with confidential and sensitive information, handle stress, and prioritize their own workload required. Operative knowledge of MS Office software and Google programs required. Valid driver’s license required in incumbent’s legal name and current address with no provisional restrictions. Minimum 18 years of age required.

Specialized Knowledge and Requirements

Advanced knowledge of CPT coding, CMS guidelines and 3rd party billing requirements. Coding Certification (CPC, COC, CCS or AAPC) required.

Required Knowledge, Skills and Abilities:

1. Safety First – You act in accordance with our safety policies, procedures and Bancroft approved practices. You exercise good judgment when confronted with safety related decisions. Your actions demonstrate that your first concern is to insure the safety of the individuals we support, yourself, staff, community, and others (includes, but is not limited to, safe driving, safe working area, and safe living environment).

2. Customer Service- You are viewed by others as professional, approachable, friendly, and helpful. You see yourself as the face, the reputation, and the integrity of Bancroft. You demonstrate knowledge of your customers (internal and external) and take steps to understand and address their current needs, and anticipate future needs. You are sensitive to the importance of customer satisfaction, and interactions result in positive outcomes.

3. Responsibility – You hold yourself accountable for desired outcomes and for meeting expectations. You work diligently to achieve goals, minimize risk, and take responsibility and ownership of your own actions, work product, and services provided. You demonstrate this by completing assignments on time, working independently, and by being dependable. You get the job done, report to work as scheduled and on time. You use leave appropriately and comply with reporting absences in accordance with our procedure.

4. Respectful – You treat others fairly, consistently, and with dignity. You display personal and professional boundaries. You use positive and pro-social interactions. You resolve conflict constructively, directly, and professionally. Finally, you clearly welcome and accept the differences in others and work well with others in a diverse environment.

5. Team Focused – You understand your role on the team and contribute towards its success. You place the team’s interests ahead of your own. You work cooperatively with others and you actively listen. You bring new ideas and energy to the group. You actively support team decisions once they are made.

6. Capable Communicator – You readily share information or knowledge needed by others. You routinely promote open communication by seeking and providing feedback. You effectively and appropriately convey your thoughts both verbally and in writing so that others understand. You utilize communication technology effectively, responsibly, and within policy.

7. Positive Initiative – You lead and influence others by example. You take pride in your work, and demonstrate a “can do” attitude while completing assignments and / or when challenged with obstacles. You effectively manage unexpected events, and you act on opportunities to improve the services that we provide to our customers.

8. Empowerment - Becoming strong and confident, especially in controlling one’s life and claiming one’s rights. Take initiative to pursue needed improvements (See it - Own it - Solve it - Do it). Provide opportunities for others to expand their involvement and personal or professional growth. Ask colleagues to represent you at meetings when you are not available. Collaborate with others to be inclusive in problem solving and decision making. Support persons serve in making their own decisions, rather than decide for them or tell them how to decide. Make decisions that fall within your responsibility. Effectively delegate to others, and support their decisions. Report things that are a concern or do not appear to be appropriate. Find ways to help individuals served learn and grow in everything they do. Freely share ideas or suggestions. Be inquisitive, ask questions, and offer support. Develop the courage to take personal risks when needed to support each other and the organization’s success.