Revenue Integrity Compliance Auditor

Department/Unit: AMHS Revenue Integrity Work Shift: Day (United States of America) Salary Range: $70,068.00 - $108,605.00 Under the direction of the Revenue Integrity Audits Manager, this position is responsible for providing audit and research support to physicians, advanced practice professionals, professional fee billing staff, clinic staff, administrators, and other affected personnel on documentation and billing requirements. Using established auditing and research techniques, determines the adequacy of medical records documentation, coding and billing for all providers across all clinical specialties. This position reads, interprets, and distributes coding and billing guidelines to all departments to ensure regulatory compliance. Essential Duties and Responsibilities Exemplifies the AMHS Values and Code of Conduct, while striving to identify compliance risk through effective and timely review of RAC Audit requests, ensuring timely appeals, as appropriate, and reporting any identified risks to Legal Services and Corporate Compliance Departments. Ensures immediate action is taken on any issues identified by Legal Services or Corporate Compliance. Builds and nurtures collaborative supporting relationships with the AMHS executive team, clinical chairs, faculty, clinicians, and other leaders across the health system and encourages, promotes, and advocates staff to ensure integration of new processes across all departments. Review clinical documentation within the patient medical record and charges in financial system in response to edits and/or inquiries from third-party payers Resolves edits based on regulatory and/or payer specific guidelines Generates appeal letters in response to denials received from payers and updates information in patient accounting system to reflect actions taken Works collaboratively with members of the revenue cycle, information systems and clinical departments toward ensuring accuracy of charges on patient accounts Performs audits on patient accounts as requested and tracks results for ongoing review by revenue cycle performance improvement and/or leadership Engages in end-to end testing scenarios as needed to ensure new charge generation and/or revisions are accurate within the information system and populate correctly in the financial billing system Performs review of clinical documentation within the electronic medical record and validates and/or add charges to patient encounter as appropriate Research and answers billing