The Charge Audit Analyst is responsible for pre-audit, auditing all accounts where audits have been ordered and/or completed by insurance companies, external audit agencies, patient requests, and concurrent review. Responsible for identifying deficiencies in regards to charting as required by insurance companies and audit agencies.
Major Position Responsibilities:
- Ensures audits are scheduled with outside auditors, Medical Records and designated Department Heads (as required by specific audits).
- Follow hospital policies/procedures for hospital audit program.
- Prepare pre-audit package on accounts scheduled for audits.
- Meet with auditors during scheduled audits--assist as needed.
- Conduct "exit" conference on all completed defense audits, and resolve as many issues as possible at that time. Emphasis on resolving audits & discrepancies at that time.
- Patient and BO requested audits
- Review all audits and determine best course of action
- Audit accounts as necessary
- Phone patients regarding audit results
- Document findings in system
- Upon audit completion:
- Review/compare with exit interview findings;
- Provide any documentation as needed to support charges and/or credits;
- Request necessary audit adjustments on patient account in system; and
- Respond to audit company in required time frame (usually 10 Days).
- Prepare reports on monthly basis showing:
- Total patient/defense, and concurrent audits for month with;
- Total gross charges
- Over charges/under charges
- Defense results
- Final determination/total gain/los
- Report any patterns seen relative to poor documentation or charting. Submit reports to the Director of Revenue Cycle and the Patient Accounting Supervisor by the fifth (5th) of each month.
- Research, analyze and clear APC/OCE edits daily.
- Routinely monitor the Federal Register and other sources for information pertaining to APC’s and outpatient payment reform.
- Work with the Charge Master to recommend changes.
- Monitor delinquent data reports and patient accounts daily to resolve any outstanding issues.
- Monitor patient accounts daily to resolve outstanding issues.
- Monitor late charges and research when they exceed 2% of monthly revenue.
- Modifier review.
- Reconcile daily room charge discrepancies.
- Works with various departments relative to charge capture.
- Reviews and clears billing edits identified in the billing platform daily. Perform other duties/tasks as assigned by the Director of Revenue Cycle Director or Patient Accounting Supervisor.
- Performs Focus/Concurrent audits and prepares a monthly report.
Safety and Infection Control Responsibilities
- Responsible to maintain a safe and clean work environment, including unit based specific safety and infection control requirements.
Qualifications: ESSENTIAL COMPETENCIES, KNOWLEDGE, & EXPERIENCE
- Minimum 3-5 years healthcare experience as Charge Auditor, required.
- Computer skills must include experience with word processing and spreadsheet software, required.
- Excellent oral and written communication skills, required.
- Process oriented skills with ability to handle multiple projects simultaneously by prioritizing responsibilities and meeting deadlines required.
- Ability to ensure the confidentiality and rights of patients and the confidentiality of hospital and departmental documents required. Knowledge of compliance concerns relative to coding, billing, reimbursement and documentation, required.
- Understanding of computer systems and their capabilities relative to coding and billing, required.
- Knowledge of current government (Medicare & MCal) billing rules and practices, required.
- Previous Charge Master experience or understanding, preferred.
- Current CA license (RN), required.
Each new hire candidate who is offered employment must pass a physical evaluation, urine drug screen and pre-employment background checks before starting work.