Chart Auditor, Full Time, Day Shift-8 Hr, Revenue Management

Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect.

Whether virtual or on campus, Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.

Job Summary:

Evaluates medical record documentation for evidence of clinical information to support charges, observation hours, status orders, charge orders etc. Coordinates with facility as needed to obtain missing documentation when applicable. Associates clinical and coding information to national and local coverage determination. Reviews the medical record, facility protocol, and other applicable documentation, which may include the verification of billing data for accuracy and completeness, following regulatory requirements, in order to resolve edits or exceptions detected during system processing of the claim in patient accounting, or the payer. Handles audits that modifiers applied are appropriate based upon reviews, and/or makes necessary adjustments to patient account charges and/or balances. Analyzes accounts for specialized billing requirements that require a review of the medical record documentation, regulatory information, and other standards. Evaluates if account combinations and account splits are appropriately applied. Coordinates audits for retrospective or concurrent, corporate special projects, and other billing reviews as identified. Reviews denial trends for documentation and charging opportunities and provides feedback on educational gaps. Works collaboratively with key stakeholders, including clinical directors and medical directors in support of departmental goals.

Job Requirements:

Education and Work Experience:

• Associate’s degree in nursing: Preferred
• Bachelor’s degree in Nursing: Preferred

Licenses/Certifications:

• Current licensed RN in the state of practice (RN), medical provider (MD), or International Medical Graduate with certification from the Educational Commission for Foreign Medical Graduates (ECGMG) or equivalent.: Required
• Registered Nurse (RN) or Medical license MD (MD) or Foreign Medical Doctor (FMD): Required

Essential Functions:

• Performs charge audits on accounts to ensure accuracy and timely billing. Documentation is appropriated, according to regulations, reconciles individual accounts and make applicable changes to the charges. Provides technical assistance and support in training staff on documentation.
• Enters all pertinent information into system on a daily basis to reflect any needed changes to the computer-generated posted charges. Uses working knowledge of inpatient/outpatient status and observation.
• Contributes to team effort by remaining flexible and open minded, maintaining cooperative working relationships, sharing resources and information, and assisting co-workers in time of need. Demonstrates the ability to make sound, productive, and ethical decisions in the performance of assigned duties.
• Demonstrates a commitment to the maintenance of positive and effective working relationships with other departments. Demonstrates enthusiasm and self-motivation in performing job duties.
• Demonstrates reliability, responsiveness to others, and competent follow-up matters requiring additional attention.
• Performs other job-related duties as assigned.

Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations, including, but not limited to, measles, mumps, flu (based on the seasonal availability of the flu vaccine typically during October-March each year), COVID-19 vaccine (required in CA, HI and OR) etc., as a condition of employment, and annually thereafter. Medical and religious exemptions may apply.

Adventist Health is a faith-based, nonprofit, integrated health system serving more than 90 communities on the West Coast and Hawaii with over 400 sites of care, including 26 acute care facilities, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of 37,000 includes employees, physicians and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope.