Location: 900 BUILDING
Employment Status: FT
The Clinical Charge Audit analyst performs detailed audits of inpatient and outpatient medical records, comparing documentation with the
itemized bill, nursing procedures, and department documented charging practices. Coordinates and reports audit outcome regarding charge
opportunities, errors, percentage of savings or losses for the facility, data processing errors, the performance of the hospital charging system
as well as documentation and justification within the medical record and itemized bill. Process Improvement quantification and education of
clinical and ancillary staff as a result of audit findings is a key component of the clinical charge audit analyst role.
Concurrent review of hospital bills to document unbilled, under billed, and overbilled items/services
Submitting charge documents as required by each facility to reconcile charges to items/services documented in the
Addressing patient concerns regarding charges and services verbally and in written form in a timely fashion
Preparing reports as required by management regarding audit results, process improvement recommendations, and
systemic billing errors
Making monthly observations and recommendations to prevent future revenue losses
Assigning accurate payment methodology from contract matrix, assuring accurate and correct reimbursement
Perform education of clinical and ancillary staff as a result of audit findings
Understanding insurance terms and contract language
Identifying correct revenue codes on supplies and/or services
Documenting results of all special project work and providing recommendations for revenue managing opportunities
relating to special projects
Demonstrate ability to effectively manage multiple projects with innovation, creativity, and vision by:
o Investigating and documenting any potential for new programs and product development
o Documenting results of all special project work and providing recommendations for revenue managing
opportunities relating to special projects
o Defense auditing of targeted medical records in conjunction with the itemized bills for charging errors,
substandard documentation, and inaccurate procedural billing
o Creative problem solving through documentation of process improvement initiatives and/or internal
RN, LPN, or Clinician with experience is preferred.
Bachelor’s Degree in a Healthcare related field required or 5+ years with bedside/patient experience.
Previous auditing experience preferred
Experience with PCs, word processing, spreadsheet, graphics, and database software applications is required.
Strong quantitative, analytical, and organization skills
Proficient in chart review, clinical record information systems, and some coding methodologies
Ability to understand and interpret medical records, hospital bills, and the charge master
Ability to understand all ancillary department functions
Ability to understand insurance terms (i.e. HMO/PP, EOB, stop loss, etc.) and payment methodologies
Ability to communicate orally and in written form
Ability to utilize and understand computer technology
Must be team-oriented with strong interpersonal skills
Computer, Copier, Scanner, Fax, Telephone
PHYSICAL DEMANDS AND WORKING CONDITIONS:
Medium Work as defined by the U.S. Department of Labor constitutes a maximum lift of 21-50 pounds on occasion and/or a
maximum lift of 11-25 pounds on a frequent basis
The work is light. Sits and walks throughout the day.
Handling office supplies and equipment.
Talking and hearing to converse with staff members and other employees or visitors.
Visual acuity to prepare and read reports.
Explanation Of Benefits (Eob)
Licensed Practical Nurse