Job Description

The Charge Auditor 3 performs audits of medical records against the itemized bill and special audit requests. Coordinates and reports audit outcomes regarding charge errors, data processing errors, and the performance of hospital charging systems, documentation and justification within the medical record and itemized bill. Acts as the hospital's representative in third party defense audits, interacts with patients requesting independent review of their account, and coordinates con-current reviews of large dollar accounts prior to final billing. The position relies on education and training to complete responsibilities. Initially, it requires instruction and guidance to accomplish the job and should develop into working under general supervision.



Charge Auditing: This will be satisfactorily performed when...
+ Audits of inpatient and/or outpatient medical records, comparing the medical record documentation with the itemized bill, nursing procedures, and department documented charging practices are audited in detail.
+ Defense auditing of targeted medical records is defended in conjunction with the itemized bills for charging errors, substandard documentation, and inaccurate procedural billing.
+ Concurrent review of hospital bills to document unbilled, under billed, and overbilled items/services are performed.
+ Accurate payment methodology from contract matrix is assigned, assuring accurate and correct reimbursement.
+ Correct service codes on supplies and/or services are identified.
Revenue Capture & Audit Education: This will be satisfactorily performed when...
+ Monthly observations and recommendations are made to prevent future revenue losses.
+ Patient concerns regarding charges and services verbally and in written form are addressed in a timely fashion (14-day return time from receipt)
+ Carve-out exclusion are reviewed to identify specific prosthetics, orthotics, and other implantable devices.
Process Improvement & Compliance: This will be satisfactorily performed when...
+ Reports are prepared as required by management regarding audit results, process improvement recommendations, and systemic billing errors.
+ Results of all special project work are documented and recommendations for revenue managing opportunities relating to special projects are provided.
+ Any potential for new programs and product development are investigated and documented.
Other Duties As Assigned: This will be satisfactorily performed when...
+ Other duties as assigned are completed.
+ Assistance with projects is provided as needed.
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4 yrs experience in Healthcare Graduate of accredited school of Nursing - LPN or Associates Degree in HIM None Strong quantitative, analytical, and organization skills. Good communication & Negotiating Skills. * LPN or RHIT