REVENUE INTEGRITY AUDITOR

Overview

 

 

Revenue Integrity Auditor

Full Time, 80 Hours Per Pay Period, Day Shift

 

Covenant Health Overview:

Covenant Health is East Tennessee’s top-performing healthcare network with 10 hospitals and over 85 outpatient and specialty services, and Covenant Medical Group, our area’s fastest-growing physician practice division. Headquartered in Knoxville, Covenant Health is a community-owned, not-for-profit healthcare system and the area’s largest employer with over 11,000 employees. Covenant Health is the only healthcare system in East Tennessee to be named six times by Forbes as a Best Employer. 

 

 

Position Summary: 

Performs complex level professional internal auditing work and appeals. Work involves leading or conducting process, financial, appeals, and compliance audit projects for Covenant Health entities as they relate to charging, coding, documentation, and billing compliance. Also provides consulting services to the organization’s management and staff and may participate in requested investigations. Maintains all organizational and professional ethical standards. Works independently under limited supervision with significant latitude for initiative and independent judgment.  Reports to the Revenue Integrity Manager.

 

Recruiter: Kathleen Rice || kkarnes@covhlth.com || (865) 368-7313

Responsibilities

• Identifies and evaluates company risk areas and provides auditing procedures related to documentation and reimbursement to include: documenting client processes and procedures, assessing risks and adequacy of related manual and automated internal controls, developing criteria, and reviewing and analyzing findings. Also provides corporate oversight of any current departmental audit programs.
• Reviews ADR log, Appeals Database, and Payor websites to identify audit issues and proactively trend data.
• Reviews and studies all information published by CMS and the OIG via the Federal Register, fraud alerts, OIG advisory opinions, and other publications relative to coding, billing, and reimbursement compliance in order to ensure compliance.
• Reviews information from Third Party Payors relative to claims charging, coding, and billing in order to ensure compliance.
• Performs research and analysis of charges, CPT coding, modifiers, and billing processes to ensure compliance with Medicare/Medicaid guidelines and other insurance Payors and to maximize reimbursement.
• Explains charges and charging procedures to third party insurance companies for defense audits as applicable.
• Coordinates with appropriate parties the complete/partial payment or repayment of the claims, as described in the Audit Policy, as findings are identified that are either over-payments or underpayments.
• Communicates or assists in communicating the results of audit and consulting projects via written reports and oral presentations to management and audit committee.
• Documents all audit activities in a designated location; reports statistics and identified problems monthly or more urgently if deemed necessary.
• Monitors audits performed at the department level in order to ensure that data is appropriate, being maintained, and being disseminated to leadership as indicated.
• Assists with Payor denials when necessary.
• Assists with special projects and performs other duties as needed and requested by the Vice President of Patient Account Services and Corporate Manager of Revenue Integrity.
• Supports, models, and adheres to the desired behaviors of the KBOS Constitution for quality which are: celebrate and reward successes, seek out better ways to do our job, set improvement goals and standards striving to meet or exceed them, participate in forming and being part of work teams when necessary, and do not say "It's not my job.”
• Works in conjunction with health information management, patient accounting, information systems, and other personnel to assist with implementation of solutions to maintain a proper compliance stance.
• Under the direction of Revenue Integrity Manager, works with the Manager of Revenue Processes to assist with implementation of solutions to maintain a proper compliance stance.
• Under the direction of Revenue Integrity Manager, works with the Chief Compliance Office relative to coding, billing, and reimbursement compliance issues.
• Under the direction of Revenue Integrity Manager, works with the Chief Compliance Officer in the development and ongoing activities involved in the baseline and periodic compliance audits and compliance programs as deemed appropriate by manager.
• Works with contract management personnel in the review of contracts and other reimbursement o