The Charge Audit Specialist 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. They will also plan, conduct and evaluates reviews and audits of clinical documentation and billing practices for conformity with applicable regulatory requirements (training will be provided). The Charge Audit Specialist will identify proactive opportunities to strengthen charge capture processes, enhance regulatory compliance and facilitate appropriate revenue capture. They will also respond to third-party audits as well as charge recovery vendor solution audits. Finally, they will provide training and education to clinical/charging staff and management on appropriate documentation and charge capture processes.
Responsibilities and Duties
• Conducts reviews/audits to identify potential charging and billing issues including lost revenue opportunities; prepares reports based on findings, and provides summary of findings to impacted partners [70%]
• Identifies, researches and analyzes charging and billing errors and/or omissions, working with appropriate staff/team members; ensures that revisions/corrections forwarded and incorporated in processing systems in timely manner. [10%]
• Stays current with CMS, AHA and state coding/charging and reimbursement guidelines – training and on the job coaching will be provided. [10%]
• Other duties as assigned to meet client expectations that would include root cause analysis, research of complex charging issues, implementation of corrective actions and provide subject matter expertise during system upgrades and implementations. [10%]
Audits and reviews medical documentation for appropriate ICD and CPT coding and documentation.• Analyzes medical records and identifies documentation deficiencies.