Revenue Integrity Quality Auditor at Eskenazi Health in Indianapolis, Indiana

Job Description:

Division:Eskenazi Health



Sub-Division:Hospital



Req ID:20727



Schedule:Full Time



Shift:Days


Eskenazi Health serves as the public hospital division of the Health & Hospital Corporation of Marion County. Physicians provide a comprehensive range of primary and specialty care services at the 333-bed hospital and outpatient facilities both on and off of the Eskenazi Health downtown campus including at a network of Eskenazi Health Center sites located throughout Indianapolis.




FLSA Status



Exempt




Job Role Summary



The Revenue Integrity Quality Auditor is responsible for pre- and post-payment auditing of medical records and associated clinical documentation to ensure proper charge capture, and billing in accordance with standard billing policies and reimbursement principles. This position is responsible for assisting Revenue Cycle Services, Health Information Management (HIM), Coding, Clinical Documentation Improvement (CDI), 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 is also responsible for educating clinical staff in clinic and department settings.




Essential Functions and Responsibilities

• Manages external audit requests as approved by Director, Revenue Cycle Support in conjunction with the Compliance Department


• Manages on-site third party audits, review time and exit conferences, assists with negotiation of settlements on an as needed basis


• Splits time and responsibilities between Eskenazi Health Compliance Department and Revenue Cycle Support to assist in time sensitive audit requests


• Retrieves and compiles data across multiple information systems and provides needed information for internal and external customers in a timely manner


• Conducts defense audits requested by payers or outside agencies


• Other duties include but are not limited to:
  
  
  • Conducts cost outlier and high balance account audits or post third party vendor reviews
  
  
  • Prepares written reports on trending data related to findings and facilitates sign off with leadership
  
  
  • Facilitates timely turnaround of audit results
  
  
  • Prepares written summaries of audit results, which allow clinical leadership the ability to monitor and manage their revenue capture and documentation processes
  
  
  • Keeps Revenue Cycle Support Director informed on various findings and communications with areas assigned for audit and/or process review
  
  
  • Notifies Charge Reconciliation, Charge Description Master (CDM), and Revenue Cycle Education Staff of pertinent audit issues requiring their intervention to remedy or correct
  
  
  • Other audits as assigned by management
  
  
  
  


• Works cooperatively within Revenue Cycle Support, and clinic/department leadership to ensure all charges are available within the Electronic Health Record (EHR) on an as-needed basis and according to department standards


• Requests appropriate CDM additions/modifications through the NThrive 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 and suggests documentation improvements where appropriate


• Identifies 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


• When time permits works as a Revenue Integrity Auditor

Job Requirements

• 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


• Three years of experience in hospital or physician setting with extensive Revenue Cycle knowledge


• Two years of hospital audit experience with a concentration in High Balance and Cost Outlier and/or facility-based clinic audits

Knowledge, Skills & Abilities

• Requires extensive knowledge of various coding systems, including but not limited to ICD-10-CM, CPT-4, HCPCS, as well as medical terminology, anatomy and physiology, diagnostic and therapeutic tests


• Knowledge of DRG and APC classifications and reimbursement methodologies


• Extensive knowledge of billing processes and payer requirements with special emphasis on FSSA and CMS


• Extensive knowledge of NCCI and CCI requirements for Medicare and Medicaid patients including MUE edits


• Ability to implement or facilitate change utilizing change management techniques


• Excellent oral and written communication skills; ability to effectively interact and present information with clinical and non-clinical staff


• Excellent customer service and organizational skills; detail- and task-oriented; effectively manages time and workload; ability to set appropriate priorities


• Possesses critical thinking and analytical skills


• Ability to work independently and exercise professional judgment to meet daily operational demands


• Ability to work as an effective team member


• Demonstrates team-oriented, professional conduct when resolving issues that cross operational units within Revenue Cycle and/or across Eskenazi Health


• Possesses Microsoft Excel skills including the ability to create and build new worksheets, import and sort data, and use basic formulas and functionality including pivot tables


• Possesses Microsoft Word skills to summarize audit outcomes and write internal and external correspondence


• Familiarity with information systems used at Eskenazi Health including, but not be limited to: Epic, nThrive, McKesson, OnBase, G3, and Careweb preferred


• Works cooperatively with Revenue Cycle Support, and clinic/department staff to ensure all charges are available within the EHR on an as-needed basis and according to department standards

Accredited by The Joint Commission and named as one of Indiana's best employers by Forbes magazine for two consecutive years and the top hospital in the state for community benefit by the Lown Institute, Eskenazi Health's programs have received national recognition while also offering new health care opportunities to the local community. As the sponsoring hospital for Indianapolis Emergency Medical Services, the city's primary EMS provider, Eskenazi Health is also home to the first adult Level I trauma center in Indiana, the only verified adult burn center in Indiana and Sandra Eskenazi Mental Health Center, the first community mental health center in Indiana, just to name a few.



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