Charge Audit Specialist

JOB SUMMARY 

This job is responsible for ensuring that all appropriate billing charges are being captured, documented, charged and reimbursed for the assigned department in accordance with policies and procedures, and applicable regulatory standards and requirements.  Plans, conducts and evaluates reviews and audits of clinical documentation and billing practices for conformity with applicable regulatory requirements. Identifies proactive opportunities to strengthen charge capture processes, enhance regulatory compliance and facilitate appropriate revenue capture.  Responds to third-party audits as well as charge recovery vendor solution audits. Provide training and education to clinical/charging staff & management on appropriate documentation and charge capture processes.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Conducts reviews/audits to identify potential charging & billing issues including lost revenue opportunities; prepares reports based on findings, and provides summary of findings to impacted departments.
• Works with clinical departments and other impacted departments to ensure audit findings are addressed and to assist in implementing best charging practice moving forward.
• Identifies, researches and analyzes billing errors and/or omissions, working with appropriate staff/team members; ensures that revisions/corrections forwarded and incorporated in processing systems in timely manner.  
• Provides training to staff engaged in billing data entry and related charge-capture/reconciliation activities to ensure procedures are understood and that charges booked are timely, appropriate, accurate, complete and properly documented.
• Stays current with CMS, AHA & state coding/charging & reimbursement guidelines.
• Other duties as assigned to meet client expectations that would include root cause analysis, research of complex charging issues, implementation of corrective actions & provide subject matter expertise during system upgrades & implementations.

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Knowledge of audit principles and guidelines.
• Knowledge of the accepted principles, practices and tools relating to general healthcare billing, cost accounting and reimbursement. 
• Knowledge of policies, standards and methodologies pertaining to charge capture and reconciliation, reporting, documentation and general compliance.
• Knowledge of CPT/HCPCS codes.
• Knowledge of the content and application of published health information management coding conventions, e.g., as referenced in "Coding Clinics" and/or other nationally recognized coding guidelines.
• Ability to recognize, research and correct charging/documentation discrepancies.
• Knowledge of the standards and regulatory requirements applicable to matters within designated scope of authority, including medical/legal issues.
• Working knowledge of medical terminology and abbreviations, and health care nomenclature and systems.
• Ability to use office equipment and automated systems/applications/software at an acceptable level of proficiency.
• Ability to establish and maintain effective working relationships as required by the duties of the position.
• Strong communication skills.
• Strong Excel/Powerpoint/Outlook Skills

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment.  This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience preferred to perform the job.

• Five years recent directly related work experience in a healthcare environment with significant exposure to healthcare coding/billing/reimbursement or completion of a recognized course of study for health information practitioners or coding specialists and three years coding experience in an acute hospital health information management department  
• Applicable clinical or professional certifications and licenses such as LVN/LPN and RN highly desirable
• Hospital charge audit experience highly desirable

PHYSICAL DEMANDS 

The physical demands described here are representative of