Chart Auditor in Santa Fe Springs, CA at Pipeline Health

Date Posted: 1/13/2022

Job Snapshot

Job Description

Central Business Office

Job Title: Chart Auditor 

City: Santa Fe Springs / State: California    

Central Business Office

Day Shift

From 7:00 AM

To 4:00 PM

                                      


Job Description and Job Responsibilites

Title:  Chart Auditor

Job Summary: The Chart Auditor must work with a diverse group of health care professionals to conduct billing and coding audits related to health plans and patient complaints. They must review medical records to assure all charges are supported by clinical documentation. Has knowledge of commonly used concepts, practices, and procedures within Patient Accounting, Patient Access, and assists in identifying and selecting possible system solutions. Chart Auditor must have knowledge of government/State policies. The position will be responsible to work with all departments to ensure proper charge capture and reconciliation. The auditor should have strong project management and analytical skills and be able to handle projects simultaneously. Additionally, they should be strongly detail-oriented. This auditor should be able to work well individually or as part of a team.

Essential Functions:

  • Performs chart audits on high dollar claims
  • Performs Defense audits with outside payors
  • Identifies under and over charges
  • Identifies missing charges
  • Documents findings in financial systems and in report excel format
  • Works correspondence pertaining to audits
  • Communicates with Billing and Collections departments, and other Revenue Cycle departments.
  • Create, maintain processes for implant invoices.
  • Creatively applies job knowledge and experience to solve difficult problems and regularly provides suggestions for quality improvement.
  • Knowledge of current HCPCS Codes, Revenue Codes and pricing methodologies
  • Utilizes VitalWare for billing code validations along with training users on software
  • Assist in resolving Pre-bill and Billing edits
  • Works with all departments to recommend ways to create daily charge processes, along with charge tickets. Maximize the use of the department to support strategic and operational needs of the Hospital.
  • Assist all departments with daily reconciliation processes
  • Works with Leadership to identify training and system gaps and develop strategies to address these gaps.
  • Undertakes ad-hoc assignments as required so as to react quickly and positively to new or emergent situations.
  • Leads and participates in project teams.
  • Complies with Federal, State, and Local Laws that govern business practices.
  • Knowledge of current LCD & NCD updates
  • Performs all other duties as assigned

Job Requirements

Education/Experience:

  • Three or more years of Clinical related work experience in an acute care hospital. LVN or RN preferred. Patient Financial Services setting preferred.
  • Two or more years in a college program in healthcare; or 3-5 years of experience and/or training; or equivalent combination of education and experience. Bachelors preferred.

Skills/Characteristics:

  • Computer skills required
  • Good written and oral communication skills, training in business functions and analysis.
  • Good analytical, logical thinking and problem-solving skills, as well as critical thinking skills.
  • Excellent interpersonal skills.

Licensures/Certifications:

  • LVN or RN or Certified Coder preferred