Revenue Integrity Charge Auditor

Description

MaineHealth Corporate
Professional - Nonclinical
Req #: 81104

Summary:
The Revenue Integrity Charge Auditor role promotes the accuracy of charging practices across the organization. This position serves as a liaison between clinical areas and revenue cycle teams to translate billing needs in order to effectively collaborate with practice operations in improving charge capture for their service lines.

Key Responsibilities:

• Functions as a liaison between clinical practices and revenue cycle departments. Is a resource for providers, clinical team members, and leaders on charging workflows, charge code questions, and compliant charging.
• Performs ongoing clinical service line reviews of medical records and associated billing to identify potential charging inaccuracies. Develops action plans for corrections, quantifies revenue impact, and partners with clinical areas until resolution.
• Partners with clinic practices to implement charge capture improvements including changes to systems, operational procedures, or charging education to mitigate revenue leakage. Analyzes and identifies deficiencies and inaccuracies in recording charges for services rendered. Designs recommendations for improvements to improve financial outcomes.
• Prepares charge audit reports that are clear and concise; clearly articulates findings, revenue impact, recommendations, and action plans. Presents findings to leaders across clinical practices and revenue cycle.
• Researches, analyzes and supports charge issues raised by third party payers and / or audit companies in coordination with other resources.
• Conducts chart audits to verify compliant charging in accordance with policies and regulations. Compiles findings and assesses revenue impact for charging opportunities.
• Assists in evaluation of new clinical services for proper charging and reimbursement considerations. Ensures new charging workflows are set up to charge successfully.
• Collaborates with other departments on charging opportunities, collaborating on action plans and implementing improvements.

Required Minimum Knowledge, Skills, and Abilities (KSAs)

1. Education: Bachelor's Degree or Associate's Degree in Healthcare Finance, Health Information or a closely related healthcare field preferred.
2. License/Certifications: CCS, CCA, CPC, CPC-H, or CIRCC credential or Nursing (RN) certification preferred.
3. Experience: Four years of related work experience such as coding, billing, revenue integrity, documentation improvement, clinical practice, or medical auditing required.
4. Additional Skills/Requirements Required: Knowledge of CPT and HCPCS charging guidelines and principles required. Knowledge of CCI, MUE, LCD/NCD edits and Physician reimbursement methodologies strongly preferred.
5. Additional Skills/Requirements Preferred: Knowledge of CCI, MUE, LCD/NCD edits and Physician reimbursement methodologies preferred.

Additional Information

MaineHealth is committed to fostering a supportive, inclusive environment where care team members can thrive while making a meaningful impact in the communities we serve across Maine and New Hampshire. We offer competitive benefits including paid parental leave, flexible work options, student loan assistance, professional development opportunities, and well-being resources-so you can grow your career while feeling supported both personally and professionally.

We recognize the value each team member brings to our organization.Any offer of employmentwill depend onqualificationssuch asskills, relevant experience, education, certifications,and otherjob-relatedfactors. Thebase rangeis an estimate and does notreflect the full valueofourtotal compensationpackage.

The pay range for this position is $71,448.00to $96,636.80per year.

Compensation for part-time positions isdeterminedon a prorated basis consistent with the scheduled hours and applicable full-time equivalent (FTE).

In addition to base pay, MaineHealth offerscomprehensivebenefits, recognition programs, career growth opportunities, and,where applicable,shiftdifferentials or other incentives.

If you have questions about this role, please contact lauren.robare@mainehealth.org

Hiring Scam Alert

MaineHealth will never request financial information during the interview or pre-hiring process. All legitimate communications will come from an email address ending in @mainehealth.org. If you suspect fraudulent activity, please report it immediately to mhcareers@mainehealth.org.

Notice Regarding Maine Employer Surveillance Statute:Pursuant to Maine's Employer Surveillance Statute, prospective care team members are notified that MaineHealth may monitor, collect, record, review, or retain information related to the use of its systems, networks, applications, files, data, communications platforms (including notified recordings), smart badges, building access, company vehicle GPS data, business calls, and workplace security cameras.

Information collected may be used for legitimate business purposes, including security, safety, compliance, investigations, training, quality assurance, and operational management.