Revenue Cycle Auditor

$83,167 - $126,015/Yr

Memorial Regional Health - Craig, CO

Full-time - Mid Level

Craig, CO

Hospitals

About the position

The Revenue Cycle Auditor plays a critical role in ensuring the accuracy and compliance of registration, billing, and coding processes within the healthcare setting. This position involves conducting thorough audits to verify adherence to hospital policies, payer requirements, and regulatory standards. The auditor will analyze revenue cycle data to identify discrepancies, trends, and areas for improvement, ensuring compliance with healthcare regulations such as HIPAA and CMS guidelines. Staying updated on changes in these regulations is essential to effectively manage the revenue cycle and mitigate risks associated with non-compliance. In addition to auditing, the Revenue Cycle Auditor is responsible for preparing detailed audit reports that include findings, recommendations, and corrective action plans. These reports must be communicated to relevant stakeholders, including department heads and senior management, to facilitate informed decision-making. Collaboration with various departments such as Registration, Billing, Coding, and Finance is crucial to develop and implement process improvements that optimize revenue capture and minimize revenue leakage. The auditor will also conduct audits on current denials to determine root causes and identify patterns or trends that may affect revenue. A positive and supportive attitude is expected, as the auditor will interact with other departments to solve problems and work as part of a team. Upholding the organization's values and maintaining patient confidentiality are paramount in this role, as is the commitment to continuous quality improvement and compliance with all regulatory requirements.

Responsibilities

• Conduct thorough audits of registration, billing, and coding processes to ensure accuracy and compliance with hospital policies, payer requirements, and regulatory standards.
• Analyze revenue cycle data to identify discrepancies, trends, and areas of improvement.
• Ensure compliance with healthcare regulations, including HIPAA, CMS guidelines, and other relevant laws and standards.
• Stay updated on changes in healthcare regulations and payer requirements that impact the revenue cycle.
• Prepare frequent detailed audit reports, including findings, recommendations, and corrective action plans.
• Document and communicate audit results to relevant stakeholders, including department heads and senior management.
• Collaborate with departments such as Registration, Billing, Coding, and Finance to develop and implement process improvements.
• Identify opportunities to optimize revenue capture and minimize revenue leakage.
• Conduct audits on current denials to determine root causes and identify patterns or trends.
• Work with departments to ensure accurate charge capture and coding practices.
• Act as a positive and supportive team member to staff members and the Hospital.
• Interact with other departments in solving problems and working as a team.
• Demonstrate a professional, positive, and caring attitude.
• Perform other duties as assigned.

Requirements

• Must be able to legally work in the United States.
• Must be able to pass a background check.
• Must be able to pass a drug screen.
• Must complete employee health screening.
• Excellent analytical, organizational, and communication skills.
• Extensive knowledge in CAH and RHC billing and coding practices.
• Bachelor's Degree in Healthcare Administration, Finance, Accounting, or a related field required.
• Minimum of 5 years of experience in healthcare revenue cycle auditing, billing, coding, or related field required.
• Proficiency in Microsoft Excel required.
• Prior Revenue Cycle experience in a Critical Access Hospital and Rural Health Clinic required.

Nice-to-haves

• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent certification preferred.
• Proficiency in EPIC preferred.

Benefits

• Medical
• Dental
• Life
• Retirement
• Paid Time Off