Job Details

Overview

The Revenue Integrity Auditor will perform detailed audits of the medical record at Sentara facilities, by researching and analyzing the accuracy of the medical record documentation to the itemized bill to ensure charges are defensible under scrutiny with our payers. The Revenue Integrity Auditor ensures adherence to regulatory requirements related to billing and supporting documentation, and facilitates the completion of appeals in a timely manner. This position identifies and works collaboratively to correct discrepancies in patient charges and can participate in engagements involving payer contracts, regulatory compliance, revenue integrity, and operational assessments. This position is responsible for the coordination of external reviews / audits, including but not limited to Medicare, Medicaid, or Commercial payers; pre and/or post documentation, commercial insurance medical records request/reviews.

Key Responsibilities

• Establishing workflows, policies and procedures, software analysis and maintenance and implementation of processes and communication plans for the facility's interactions with third party auditors including but not limited to pre and post payment Medicare, Medicaid and commercial insurances reviews to ensure timely completion of review/audit documentation requests.
• Oversee all pre and post payment audit functions, medical documentation requests, and maintain a tracking system for all audits/requests activity throughout all levels of appeals.

Education

• Bachelors degree (Required)

Certification

Certification required and can be one of the following:

• CHRI Certified in Healthcare Revenue Integrity
• Certified Professional Coder (CPC)
• Certified Outpatient Coder (COC)
• Certified Professional Medical Auditor
• Certified Coding Associate
• Certified Coding Specialist
• Registered Health Information Technician
• Registered Health Information Administrator

Experience

• 3 years of healthcare appeals experience (Required)