Health Business Solutions LLC
Revenue Cycle Quality Auditor
Remote - Cooper City, FL
Position Summary:
The Revenue Cycle Quality Auditor is responsible for performing comprehensive audits of the revenue cycle processes to ensure accuracy, compliance, and efficiency. This role involves evaluating billing, coding, claims processing, and accounts receivable activities to identify discrepancies, areas for improvement, and adherence to regulations. The auditor will work closely with the Revenue Cycle Quality Manager to implement corrective actions and optimize revenue cycle performance.
Key Responsibilities:
- Audit and Review:
- Conduct detailed audits of billing, coding, and claims processing activities.
- Review patient accounts, medical records, and related documentation for accuracy and compliance.
- Identify discrepancies, errors, and areas of non-compliance with regulations and policies.
- Compliance Monitoring:
- Ensure adherence to federal, state, and local regulations, including HIPAA, Medicare, and Medicaid requirements.
- Monitor compliance with internal policies and procedures.
- Report any compliance issues or violations to the Revenue Cycle Quality Manager.
- Data Analysis:
- Analyze audit findings to identify trends, patterns, and root causes of errors.
- Prepare detailed audit reports summarizing findings, recommendations, and corrective actions.
- Present audit results to the Revenue Cycle Quality Manager and other stakeholders.
- Process Improvement:
- Collaborate with the revenue cycle team to develop and implement process improvement initiatives.
- Provide recommendations to enhance the efficiency and accuracy of revenue cycle operations.
- Track the effectiveness of implemented changes and report on outcomes.
- Training and Education:
- Assist in developing training materials and programs to address identified issues and improve staff performance.
- Conduct training sessions for revenue cycle staff on best practices, compliance, and quality standards.
- Provide ongoing support and guidance to staff to ensure continuous improvement.
- Documentation and Reporting:
- Maintain accurate and organized records of audit activities and findings.
- Prepare regular reports for management, highlighting key audit metrics and areas of concern.
- Ensure all documentation complies with legal and organizational standards.
- Technology Utilization:
- Utilize revenue cycle management software and auditing tools to conduct audits and analyze data.
- Stay updated on the latest technology trends and advancements in revenue cycle auditing.
- Recommend technology solutions to enhance audit processes and efficiency.
Qualifications:
Education:
- Bachelor’s degree in Healthcare Administration, Business Administration, Finance, or a related field. Relevant work experience may be considered in lieu of a degree.
Experience:
- Minimum of 3 years of experience in healthcare revenue cycle management or auditing.
- Proven experience in billing, coding, and claims auditing within a healthcare setting.
Skills:
- Strong knowledge of healthcare billing, coding, and compliance regulations (e.g., HIPAA, Medicare, Medicaid).
- Excellent analytical and problem-solving skills.
- Proficiency in revenue cycle management software and auditing tools.
- Strong attention to detail and organizational skills.
- Effective communication and interpersonal skills.
- Ability to work independently and manage multiple tasks simultaneously.
Certifications:
- Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Internal Auditor (CIA), or similar certification preferred.