Revenue Integrity Charge Auditor (Remote)

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Day - 08 Hour (United States of America)

This is a Stanford Health Care job.

A Brief Overview
The Charge Auditor performs auditing activities, including complex cases that require extensive research, interpretation and application of laws and regulations. Charge Auditor evaluates the adequacy and effectiveness of internal and operational controls designed to ensure that processes and practices lead to appropriate execution of regulatory requirements and guidelines related to professional or facility and documentation, charging, coding and billing, including federal and state regulations and guidelines, CMS (Centers for Medicare and Medicaid Services) and OIG (Office of Inspector General) compliance standards.

Locations
Stanford Health Care

What you will do

• Conducts defensive charge audits, self-pay/patient requests, or other special audit projects, as requested, comparing itemized bills to corresponding medical records and identifying documented services unbilled and charges for services not documented that need to need to be removed from an account
• Conducts audits for Medicare/Medicaid Cost Outlier accounts prior to billing, ensuring itemized bill is accurate.
• Conducts retrospective audits as requested.
• Collaborates with RI CDM to optimize the integrity of the Chargemaster
• Applies consistent and standardized compliance monitoring methodology for sample selection, scoring and benchmarking, development and reporting of findings.
• Prepares written reports of review findings and recommendations and presents to management and maintains monitoring records.
• Researches, abstracts and communicates federal, state, and payor documentation, and billing rules and regulations; stays current with Medicare, Medi-Cal and other third party rules and regulations including ICD-10 and CPT code updates.
• Performs defense auditing of targeted medical records in conjunction with the itemized bills for charging error, substandard documentation and inaccurate procedural billing.
• Performs concurrent review of hospital bills to document non-billed, underbilled, and overbilled items/services.
• Utilizes charge documents as required by Health System to reconcile charges to items/services documented in the medical record.
• Prepare reports by management regarding audit results, process improvement recommendations and systemic billing errors.
• Make monthly observations and recommendations to prevent future reimbursement losses.

Education Qualifications

• Bachelor’s degree in a work-related discipline/field required. Required

Experience Qualifications

• Three (3) years of progressively responsible and directly related work experience Required

Required Knowledge, Skills and Abilities

• Ability to analyze and develop solutions to complex problems
• Ability to communicate effectively in written and verbal formats including summarizing data, presenting results
• Ability to comply with the American Health Information Management Associate's Code of Ethic and Standards and applicable Uniform Hospital Discharge Data Set (UHDDS) standards
• Ability to establish and maintain effective working relationships
• Ability to judgment and make informed decisions
• Ability to manage, organize, prioritize, multi-task and adapt to changing priorities
• Ability to use computer to accomplish data input, manipulation and output
• Ability to work effectively both as a team player and leader
• Knowledge of Epic EMR and billing
• Knowledge of charge capture workflows and CDM
• Knowledge of DRG/APC reimbursement
• Knowledge of health information systems for computer application to medical records
• Knowledge of ICD-10-CM & CPT coding conventions to code medical record entries; abstract information from medical records; read medical record notes and reports; set accurate Diagnostic Related Groups
• Knowledge of standards and regulations pertaining to the maintenance of patient medical records; medical records coding systems; medical terminology; anatomy and physiology and study of diseases
• Knowledge of governmental payment practices for Medicare and MediCal
• Working knowledge of commercial payer reimbursement models
• Knowledge of Medicare billing practices.
• Proficient EXCEL, WORD, PowerPoint skills

Licenses and Certifications

• RN - Registered Nurse - State Licensure And/Or Compact State Licensure required . or
• CCS - Certified Coding Specialist required . or
• CPC and/or CCSP - Certified Professional Coder required . or
• Certified Outpatient Coder - COC required . and
• CPC required . or
• RHIT - Registered Health Information Technician required . or
• RHIA - Registered Health Information Administrator required .

Physical Demands and Work Conditions
Blood Borne Pathogens

• Category III - Tasks that involve NO exposure to blood, body fluids or tissues, and Category I tasks that are not a condition of employment

These principles apply to ALL employees:

SHC Commitment to Providing an Exceptional Patient & Family Experience

Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.

You will do this by executing against our three experience pillars, from the patient and family’s perspective:

• Know Me: Anticipate my needs and status to deliver effective care
• Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health
• Coordinate for Me: Own the complexity of my care through coordination

Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.

Base Pay Scale: Generally starting at $52.69 - $69.82 per hour

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.