Auditor, Revenue Cycle

We are recruiting for a motivated Auditor, Revenue Cycle to join our team!

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Department
Enterprise Compliance Services

Job Summary

Under general supervision, responsible for the day-to-day administration of Denver Health and Hospital Authority's (DH's), government and non-government, claim recovery programs. Serve as primary contact and Subject Matter Expert (SME) for all audits. Conducts payer audits, confirms timely response to audit requests, denials and appeals, and determines the appropriate response to the audit findings in collaboration with a multi-disciplinary team. Facilitates the Regulatory Financial Audit Action Team (RFAAT) and works closely with other contributing departments. Evaluates and reports risk and develops workflow redesign if necessary. Maintains DH's audit tracking and reporting tool and periodically reports audit and appeal process results to Executive Staff and the American Hospital Association's RACTrac program. This process has significant financial impact to DH.

Essential Functions:

• Manages, coordinates, and monitors all aspects of government and non-government claim recovery activities including processing, maintaining and distributing letters, tracking medical record requests. Follows-up on required responses from Administration/CFO, Utilization Management, the Physician Advisor, Patient Accounting, Coding, Legal Services and Health Information Management and any others involved in the audit response process to ensure all deadlines are met. Oversees and tracks hand-offs between departments. (100%)
• Communicates, as the SME/primary contact, with all affected external entities involved in the audit process. Builds relationships with customers and increasing customer satisfaction through: (1) cultivation and maintenance extensive informal networks (2) informing auditees with the creation of a "no-surprise" audit and (3) assisting the Audit Manager in coordinating with external auditors and regulators to reduce level of effort and duplication. (0%)
• Coordinates and facilitates RFAAT meetings. This includes coordinating the scheduling, developing agenda, compiling materials and reports, leading committee discussion and performing follow-up communication as needed. Promotes team work within department and DH, including (1) cooperation with other team members, (2) sharing of ideas, (3) fulfilling commitment to other team members, and (4) assisting in removing organizational barriers and identifying resources to help the team. (0%)
• Analyzes recovery programs for proactive audit opportunities. Reviews the impact of government legislation and regulation on business operations. Demonstrates accuracy, thoroughness, and attention to detail. Applies and maintains job knowledge and technical skills in the areas of (1) audit evidence, (2) fraud concepts, (3) general information technology controls, (4) risk management techniques, (4) cost-benefit analysis,(5) word processing, spreadsheet, and database software packages associated with auditing practices, and (6) control design and application well enough to educate. (0%)
• Reviews the initial adverse audit determinations for possible appeal. In collaboration with others involved in the payer audits, directs the escalation path within the payer rules and regulations for audit appeals. Confers with appropriate resources and seeks support from DH stakeholders as needed. (0%)
• Completes analysis of audit results and shares specific findings with appropriate departments for educational purposes and process improvement. Facilitates on-going process improvement efforts with other departments such as Coding, Patient Accounting, Utilization Management, etc. (0%)
• Directs and leads the evaluation, design, testing, implementation, upgrades, support and maintenance of the DH audit tracking software. Acts as a liaison, along with the Information Systems Project Specialist, between the DH and the audit tracking software vendor. Uses DH resources responsibly through the development of pragmatic, efficient, and cost effective solutions to address identified issues or concerns. (0%)
• Assists in development and delivery of training for audit tracking software and related workflows with all responsible stakeholders. (0%)
• Utilizes data mining techniques to determine potential risk areas and if necessary, reports and discusses results with relevant individuals. Assists with self-audit topics and approaches as necessary. (0%)
• Develops and presents reports summarizing audit monitoring activities to senior leadership, as directed by the Director Compliance and Internal Audit. Provides clear and professional communication with employees and customers by (1) making complex presentations and adaptation to the audience to ensure full understanding, (2) presenting in front of an audience to clearly convey a message, (3) discussing audit findings with confidence, (4) having the ability to balance diplomacy with assertiveness, (4) identifying key decision makers and the people who influence them, (5) utilizing strong listening skills to formulate direct, responsive answers to questions, and (6) effective and clear written communication, including use proper grammar and punctuation in documentation. (0%)
• Provides leadership in the following areas: (1) some supervision, training, and direction for less experienced audit staff, and may also manage the work of some audits and infrastructure projects, (2) guidance when the audit team is off track on an assignment, and (3) encouragement of others to work as a team by feedback to help them be more productive team, and (4) assistance in drawing all members into active and enthusiastic participation. (0%)
• Demonstrates an understanding cultural sensitivity and incorporates into service delivery including: (1) maneuvering through political situations effectively, (2) negotiation of resistance effectively and win concession without damaging relationships, (3) establishing buy in with management by thoroughly working through issues, and (4) ability to communicate persuasively and diplomatically. (0%)

Education:

• Bachelor's Degree Required

Work Experience:

• 4-6 years Five years of experience required in the following areas: utilization management, hospital and/or physician billing, hospital and/or physician coding, medical record auditing, and/or legal/regulatory compliance background Required and
• Experience in compliance and healthcare auditing preferred.

Licenses:

• CCS-Certified Coding Specialist - AAPC - American Academy of Procedural Coders Required

Knowledge, Skills and Abilities:

• Exposure to clinical/ancillary and finance/business operations/
• Knowledge of Recovery Audit Contractors (RAC) and other state/federal/commercial billing audit programs.
• Knowledge of rules and regulations pertaining to hospital reimbursement.
• Analytical and decision-making skills i.e. define problems, collect data, establish facts, draw conclusions and develop recommendations.
• Ability to work independently (self-directed) and prioritize work using time management principles.
• Extensive knowledge of medical terminology, anatomy and physiology, and the disease process.
• Extensive knowledge of ICD-9-CM and CPT coding systems.
• Ability to research, interpret clinical documentation, federal, and state regulations.
• Strong organizational skills: detail-oriented, timely follow through, and meeting coordination.
• Ability to perform and complete multiple tasks within reasonable time constraints.
• Strong relationship building, facilitation, and presentation skills.
• Strong written and oral communication skills.
• Proficient in Microsoft Office Suite.
• Working knowledge of Epic.

Shift

Work Type
Regular

Salary
$77,300.00 - $119,800.00 / yr

Benefits

• Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans
• Free RTD EcoPass (public transportation)
• On-site employee fitness center and wellness classes
• Childcare discount programs & exclusive perks on large brands, travel, and more
• Tuition reimbursement & assistance
• Education & development opportunities including career pathways and coaching
• Professional clinical advancement program & shared governance
• Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program
• National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

Our Values

• Respect
• Belonging
• Accountability
• Transparency

All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.

Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver's 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation.

As Colorado's primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year.

Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.

Denver Health is an equal opportunity employer (EOE). We value the unique ideas, talents and contributions reflective of the needs of our community.

Applicants will be considered until the position is filled.