Revenue Cycle Auditor

ESSENTIAL FUNCTIONS AND BASIC DUTIES:

Supervisory-Specific Performance Expectations, Duties, and Responsibilities:

• N/A

Position-Specific Performance Expectations, Duties, and 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 HIPPA, 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.
• Positive and supportive team member to staff members and the Hospital.
• Interaction with other departments in solving problems and working as a team.
• Demonstrates a professional, positive and caring attitude.
• Performs other duties as assigned.

Organization-Specific Performance Expectations, Duties, and Responsibilities:

• Demonstrates 100% commitment to performance in accordance with the CHOICE values of MRH and representing the organization in a positive and professional manner.
• Establishes and maintains effective verbal and written communication and good working relationships with all patients, staff, and vendors.
• Adheres to MRH attire/dress code per policies and procedures.

• Utilizes initiative; strives to maintain a steady level of productivity; self-motivated; and manages activity and time.
• Completes annual education, training, in-service, and licensure/certification requirements; and attends departmental and organizational staff meetings or reads meeting minutes.
• Maintains patient confidentiality at all times.
• Reports to work on time as scheduled; completes work within designated timeframes.
• Actively participates in departmental and organizational performance improvement and continuous quality improvement activities.
• Strives to uphold regulatory requirements to ensure continual compliance with departmental, hospital, state, and federal regulations and policies.
• Follows policies and procedures for infection control, safety, and risk management to ensure a safe environment for patients, the public, and staff.

QUALIFICATIONS:

Minimum Requirements:

• Must be at least 16 years of age (21 for driving positions with a valid driver's license).
• 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 and breath alcohol test (if applicable).
• Must complete employee health meeting.
• Excellent analytical, organizational, and communication skills.
• Extensive knowledge in CAH and RHC billing and coding practices.

Required Education/Licensure/Certification:

• 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.

Experience:

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

Position Classification: Exempt

Compensation Range: $83,167 to $126,015

Benefits: Medical, Dental, Life, Retirement, Paid Time Off