Job Description
At UC Health, we're proud to have the best and brightest teams and clinicians collaborating toward our common purpose: to advance healing and reduce suffering.
As the region's adult academic health system, we strive for innovation and provide world-class care for not only our community, but patients from all over the world. Join our team and you'll be able to develop your skills, grow your career, build relationships with your peers and patients, and help us be a source of hope for our friends and neighbors.
UC Health is committed to providing an inclusive, equitable and diverse place of employment.Minimum Required: Bachelors Degree - Healthcare. Preferred: Masters Degree. | Professional Medical Auditor (CPMA) or an equivalent certification preferred. | Minimum Required: 1 - 2 Years equivalent experience. Preferred: 3 - 5 Years equivalent experience.Perform Audits:
Performs detailed and focused charge audits on inpatient and outpatient accounts.
These can include defense, prebill, and cpt/charge code line item audits.
Evaluates the appropriateness of services and procedures charged based on supporting documentation and evaluates the appropriateness of ICD, CPT, and HCPCS codes.
Reviews audit results with management and staff and considers feedback from the internal/external customers as appropriate.
Tracks, reports, and effectively communicates audit findings including reimbursement and compliance information.
Enters and maintains charge audit results data.
Present audit findings and assist in the development of constructive recommendations/education to clinical departments.
Partner with Internal Audit to perform charge related audits in their annual audit program.
Charge Capture Outreach Education & Training:
Works with revenue producing clinical department managers to develop and provide educational sessions for staff concerning issues identified through the auditing process.
Responds to clinical department questions and reviews cases as necessary, to assist with correct charge capture process and procedures.
Attends educational sessions, training sessions and task forces sessions as directed.
Charge Edits:
Responsible for reducing Accounts Receivable on Unbilled Accounts by working charge related errors.
Research and resolve a variety of issues relating to charge capture. Edit claims (DNB, Claim Edits, and Stop Bills) within scope of authority to meet and satisfy timely billing.
Responsible for the analysis and necessary corrections of patient claims/accounts as it pertains to clean claim submissions and maintain work queues.
Process Improvement:
Identify areas of improvement to improve workflow to minimize errors and/or denials.
Share and present findings and recommendation for improved workflow.
Other Duties as Assigned:
Provides occasional backup for other auditors or CDM team members.Perform Audits:
Performs detailed and focused charge audits on inpatient and outpatient accounts.
These can include defense, prebill, and cpt/charge code line item audits.
Evaluates the appropriateness of services and procedures charged based on supporting documentation and evaluates the appropriateness of ICD, CPT, and HCPCS codes.
Reviews audit results with management and staff and considers feedback from the internal/external customers as appropriate.
Tracks, reports, and effectively communicates audit findings including reimbursement and compliance information.
Enters and maintains charge audit results data.
Present audit findings and assist in the development of constructive recommendations/education to clinical departments.
Partner with Internal Audit to perform charge related audits in their annual audit program.
Charge Capture Outreach Education & Training:
Works with revenue producing clinical department managers to develop and provide educational sessions for staff concerning issues identified through the auditing process.
Responds to clinical department questions and reviews cases as necessary, to assist with correct charge capture process and procedures.
Attends educational sessions, training sessions and task forces sessions as directed.
Charge Edits:
Responsible for reducing Accounts Receivable on Unbilled Accounts by working charge related errors.
Research and resolve a variety of issues relating to charge capture. Edit claims (DNB, Claim Edits, and Stop Bills) within scope of authority to meet and satisfy timely billing.
Responsible for the analysis and necessary corrections of patient claims/accounts as it pertains to clean claim submissions and maintain work queues.
Process Improvement:
Identify areas of improvement to improve workflow to minimize errors and/or denials.
Share and present findings and recommendation for improved workflow.
Other Duties as Assigned:
Provides occasional backup for other auditors or CDM team members.
Equal Opportunity Employer - minorities/females/veterans/individuals with disabilities/sexual orientation/gender identity
