Revenue Capture and Audit Specialist

3 weeks ago

Oak Brook, Illinois, United States Advocate Health Full time

Major Responsibilities:

  • Provide billing and revenue accuracy by conducting charge capture/bill audits (concurrent, prospective and retrospective).
    • 4)Escalate issues regarding revenue capture or incorrect charging practices when appropriate
    • 5)Escalate issues regarding nursing documentation when appropriate
    • 1)Perform proactive/concurrent audits for assigned departments or as appropriate to identify areas of billing discrepancies and/or duplicate charges
    • 2)Perform periodic retrospective, charge capture reviews of assigned departments including review of medical record, encounter form, UB-92, and electronic billing tools to identify charging/billing issues
    • 3)Communicate identified audit issues with the department management team. Develop and document improvement process solution with the department management
  • Provide orientation, education training and information to any revenue producing department regarding charge capture, policies, procedures, and underlying processes, ensuring charge accuracy and billing compliance.
    • 3)Identify, communicate, and educate inconsistent trends in billing with specific departments.
    • 1)Perform analysis of charges that correlate with documented medical/nursing interventions
    • 2)Verify questionable discrepancies found on bill audits by contacting appropriate internal departments
  • Liaison with other hospital departments to solve their internal billing problems on an as-needed basis.
    • 1)Identifies quality assurance project opportunities.
    • 2)Collects, reports, and maintains appropriate data in relation to charge capture.
    • 3)Develops and implements plans for corrective measures in conjunction with the clinical Manages and the Care Connection liasion
    • 4)Participates in ED audit management meeting as required by ED department manager
    • 5)Participates in interdisciplinary teams
    • 6)Review, identify, and process late, missing or lost charges for various hospital departments on an emergency and as needed basis
    • 7)Verify and respond to questions from internal departments regarding billing accuracy
    • 8)Maintain HIPPA security and compliance of medical records for audit use
    • 9)Establish and maintain effective communication with Admitting, Medical Records, Patient Accounts, Nursing Directors/Managers and other areas within the hosptial.

Education/Experience Required:

  • -3-4 Years previous hospital clinical or coding experience. -Knowledge of third-party healthcare insurance plans

Knowledge, Skills & Abilities Required:

  • Basic computer skills. -Excellent communication skills required. -Familiarity with hospital applications and basic Microsoft Office and Windows applications
  • -Certified Coding Associate (CCA) valid and current certification required

Physicial Requirements and Working Conditions:

  • -Ability to coordinate large projects; work under time pressures and meet deadlines.
    --Ability to lift 20# -Ability to work independently. -Skill understanding and analyzing patient bills and medical records. -Ability to interact with associates at all levels within the organization. Ability to provide superior customer service. -Ability to investigate, analyze and apply contract language, billing guidelines, medical and reimbursement policies. -Strong written, and oral communication skills and be capable of handling confrontational encounters in a positive manner. -Must have proven problem-solving abilities and strong analytical skills -Travel to local meetings at various sites as necessary -Ability to work under time pressure and meet deadlines. -Ability to communicate effectively and work independently. -Effective organizational skills. -Skill in understanding charge capture and analyzing patient bills. -Familiar with reading medical chart.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

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