Rev Cycle Internal Auditor

About the role

Department/Unit: Compliance Office

Work Shift: Day (United States of America)

Salary Range

$84,783.00 - $131,414.00

The Senior Revenue Cycle Auditor will be a key contributor within the Compliance and Audit department, leading and supporting audit and compliance initiatives. This role will encompass project management, research and analytical tasks while also collaborating across internal and external teams, IT and business operations to ensure and enhance the integrity of revenue cycle processes.

The successful candidate will plan, coordinate and manage project activities to ensure goals and objectives are accomplished within prescribed timeframes and budget parameters and that results are proactively communicated to business stakeholders.

This individual will also analyze clinical and financial data to find discrepancies and work with various teams to improve the revenue cycle, resolve billing issues, and ensure proper reimbursement for healthcare services. This role will also be responsible for following up on corrective action measures related to outcomes of project activities.

Core Duties and Responsibilities

• Plan, coordinate, and manage projects to ensure project initiatives and timelines are met, working with outsourced teams to develop and define project scope and initiatives
• Collaborate with and communicate project initiatives with business stakeholders to facilitate active engagement and timely response to requests
• Prepare, present, and distribute project status reports to stakeholders
• Apply understanding of regulations and System billing process to assist in evaluating whether procedures and services are properly ordered and billed
• Review and evaluate audit results to determine risk exposure, impact to revenue cycle, identify clinical documentation improvement opportunities, and make recommendations for areas of continued audit focus
• Identify trends based upon audit results and provide recommendations for education, training and corrective actions to internal stakeholders, as needed
• Monitor and follow-up on corrective action plans to determine additional training needs to achieve an environment of sustainable performance
• Ensure availability of performance measurement data for review and analysis; evaluate and drive risk management process improvements, efficiencies and workflow enhancements
• Evaluate the environment of sustainable performance of the Revenue Cycle Operations and provide observations and recommendations for improvements
• Maintains knowledge of new/existing government regulations and third-party payor requirements with regard to documentation, coding and billing requirements. Maintain professional credentials through continuing education as required by national and state accreditation organizations
• Ability to work independently, use varying resources to conduct research over subject matter topics, identify opportunities for improvement and provide solutions, and coordinate multiple projects simultaneously
• Ability to communicate effectively across various cross-functional departments
• Represent Albany Med Health System in a professional manner at all times and in all interactions
• Perform all other duties as assigned

Minimum Qualifications

Education

• Minimum Bachelor’s degree required

Licensure, Certification & Registration

• Certified Professional Coder (CPC) designation or other Coding Professional Certifications required

Experience

• 4+ years’ experience within the healthcare industry and coding experience required

Skills, Knowledge & Abilities

• In-depth knowledge of hospital revenue cycle and understanding of the Charge Description Master (CDM), charge errors, and charge reconciliation process; EPIC experience a plus
• Strong verbal and written communication skills to effectively teach and interact with internal and external parties
• Strong organizational, project management and leadership skills required

• Thank you for your interest in Albany Med Health System!
• Albany Med Health System is an equal opportunity employer.

This role may require access to information considered sensitive to Albany Med Health System, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that:

Access to information is based on a “need to know” and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Med Health System policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.