Charge Integrity Auditor - Revenue Integrity

Your job is more than a job

The Charge Review Auditor plays a key role in ensuring the accuracy and completeness of clinical charge capture and billing processes. This position focuses on auditing medical records and charge capture reports to verify proper coding, documentation, and compliance with regulatory guidelines. By collaborating with clinical, financial, and coding departments, the Charge Review Auditor helps enhance revenue integrity and optimize the revenue cycle. This position will work with departments to minimize lost charges and denials.

Your Everyday

• Review patient medical records, charge capture reports, and billing data to ensure accurate coding, appropriate charge capture, and compliance with applicable regulations.
• Analyze medical records to ensure services rendered are correctly charged and billed based on diagnosis, procedure codes, and payer guidelines.
• Ensure that documentation meets internal and external billing regulations, including Medicare/Medicaid guidelines, and follows coding standards (e. g. , ICD-10, CPT, HCPCS).
• Identify discrepancies and deficiencies in documentation, providing recommendations for corrective actions to maintain compliance.
• Work closely with clinical, billing, coding, and revenue cycle teams to resolve discrepancies, charge capture issues, and billing errors by serving as a liaison between clinical departments and the revenue cycle team to ensure cohesive communication and charge accuracy.
• Monitor and identify trends in charge capture, denials, and billing errors. Prepare reports on findings, recommending areas for focused audits and process improvement.
• Present audit findings to departmental leadership and provide actionable recommendations for enhancing revenue capture and compliance. Offer detailed feedback to providers on missing, incomplete, or unclear documentation, providing guidance on how to improve charge capture accuracy.
• Conduct training and education sessions for clinical staff, billing teams, and coders to address common audit findings and promote compliance with regulatory standards.
• Stay updated on federal, state, and payer regulations related to billing, coding, and charge capture, including CMS guidelines, Local Coverage Determinations (LCD), and National Coverage Determinations (NCD). Apply regulatory knowledge to ensure compliance during audits and recommend changes to processes when necessary.
• Participate in initiatives aimed at improving clinical documentation accuracy, charge capture processes, and overall revenue integrity.
• Support Clinical Documentation Improvement (CDI) teams in identifying documentation gaps that impact revenue and compliance.
• Respond to audit requests from external agencies or internal stakeholders, providing thorough documentation review and offering recommendations for improvement.
• Collaborate on appeals and denial management by reviewing the documentation to support claims.
• Contribute to the development and refinement of policies, procedures, and best practices related to charge capture, revenue cycle, and audit processes.
• Engage in continuous process improvement efforts to enhance operational efficiency and maximize revenue capture.
• Maintain up-to-date knowledge of billing, coding, and compliance standards by attending industry workshops, seminars, and webinars.
• Actively participate in team meetings, training programs, and professional development activities.

• 5+ years of experience in healthcare auditing, revenue integrity, revenue cycle management, healthcare finance, or a related field
• Strong knowledge of Chargemaster (CDM) management, including charge capture processes, coding (CPT, HCPCS, ICD-10), and compliance with CMS and third-party payer requirements.
• 3+ years of Epic experience with an auditing background

• Required - bachelor's degree in nursing, Healthcare, Health Information, or another related field
• Preferred - master's degree in healthcare, or another related field.

• Minimum: Applicable professional certification through AHIMA (RHIA, RHIT, CCS), RN, LPN, or AAPC (COC, CPC) or Epic Certified
• Preferred: RN or LPN Degree from an accredited program, AHIMA Credentials with experience in Coding, CDI or other related functions.

• Ability to work independently, efficiently, and accurately prioritizing varying workloads required. Strong quantitative, analytical, and organization skills required.
• Must be able to understand all ancillary department functions.
• Must be able to understand insurance terms (i. e. HMO/PP, EOB, stop loss, etc. ) and payment methodologies.
• Excellent communication skills to deal effectively with the public, department staff, hospital staff, and medical staff required.
• Positive attitude to work effectively with department staff required.
• Clinical knowledge associated with
• Knowledge of computers (Excel, Word)
• This position will have a basic understanding of the work that CDM Analysts and Charge Analysts do so they are able to assist in these areas. This position works independently and must be self-motivated. Analytical skills, working knowledge of the various systems and departmental processes are essential.
• Strong Organizational Skills
• Math aptitude
• Detail Oriented

• Deliver healthcare with heart.
• Give people a reason to smile.
• Put a little love in your work.
• Be honest and real, but with compassion.
• Bring some lagniappe into everything you do.
• Forget one-size-fits-all, think one-of-a-kind care.
• See opportunities, not problems - it's all about perspective.
• Cheerlead ideas, differences, and each other.
• Love what makes you, you - because we do