RCM Integrity Auditor

RCM Integrity Auditor Overview

About Us:

Somnia Anesthesia, Inc is a leading healthcare organization dedicated to providing exceptional patient care and services. We are committed to excellence and innovation in the healthcare industry. 

Position Summary:

The RCM Integrity Auditor is responsible for conducting audits and reviewing clinical documentation to ensure proper charge capture, billing in accordance with standard billing policies and compliance standards. This individual is responsible for assisting the RCM Directory of Revenue Integrity and Education, and Manager of Coding with resolution of coding/ billing issues, participating in external/internal audit requests, payer audits, and special projects as needed.

RCM Integrity Auditor Responsibilties

• Audit medical records to identify missed charges, incorrect coding, and other inconsistencies that result in missed billing opportunities.
• Perform Root Cause Analyses and report findings that identify common issues, including over-coding, under-coding, and missed billing opportunities.
• Retrieves any missing patient information and documentation required for billing.
• Complete coding of unbilled records identified through audits.
• Prepare detailed audit reports, outlining findings, recommendations, and corrective actions needed to address identified issues.
• Provide training and guidance to staff on potential coding/documentation issues and best practices for maintaining medical integrity.
• Conduct ad-hoc audits as needed to provide root cause analysis and recommendations for resolution.
• Analyze RCM data and trends to identify areas for improvement and risk mitigation in healthcare operations.
• Provide resolution of missing documentation tasks. Retrieve or request necessary documents, code for billing, and data entry.
• Provide coding support to cross-functional team inquiries and special projects.
• Develop and implement strategies to improve audit processes and enhance overall operational integrity

RCM Integrity Auditor Qualifications

• Minimum 3 years coding/auditing experience.
• Must have and maintain an approved coding credential, CPC through AAPC (American Academy of Professional Coders) or AHIMA
• Must have or obtain at least one additional certification (CANPC or CPMA), or within 1 year of employment.
• Extensive knowledge of medical billing software and electronic medical records.
• Well-rounded knowledge of CMS requirements claims processing, billing/coding guidelines, and the Revenue Cycle process.
• Proficient PC skills, including Microsoft 365, Excel proficiency to include basic formulas, concatenate, VLOOKUP, and pivot tables).
• Previous coding experience within Anesthesia or General Surgery preferred.
• Clinical Documentation compliance and regulatory requirements preferred.