Health Business Solutions LLC

Job Summary:

The Revenue Cycle Quality Auditor is responsible for evaluating the accuracy and effectiveness of the revenue cycle processes, including billing, coding, collections, and patient financial services. The auditor will perform detailed audits to ensure compliance with internal policies, external regulations, and industry standards, providing recommendations for process improvements.

Key Responsibilities:

Audit and Analysis:

• Conduct regular audits of the revenue cycle processes, including patient registration, coding, billing, claims submission, payment posting, and collections.
• Analyze data to identify trends, discrepancies, and opportunities for improvement.
• Review patient accounts and claims to ensure accuracy in billing and coding.
• Validate that charges are correctly applied according to service rendered and payer contracts.

Compliance and Regulation:

• Ensure compliance with federal, state, and local regulations, as well as organizational policies and procedures.
• Stay updated on changes in healthcare regulations and payer requirements.
• Identify areas of non-compliance and work with relevant departments to correct them.

Reporting:

• Prepare detailed audit reports that outline findings, risks, and recommendations.
• Present audit findings to management and relevant stakeholders.
• Develop and maintain audit documentation and records.

Process Improvement:

• Collaborate with department heads and team members to implement recommended improvements.
• Monitor the effectiveness of implemented changes and provide ongoing feedback.
• Participate in the development of training programs to address identified gaps.
• Identify root causes of errors and provide remedial training as needed

Training and Education:

• Provide guidance and training to revenue cycle staff on best practices, compliance, and process improvements.
• Assist in developing educational materials and programs to enhance staff knowledge and performance.

Collaboration:

• Work closely with billing, coding, and patient financial services teams to address audit findings.
• Function as a resource for staff regarding revenue cycle policies and procedures.
• Participate in cross-functional meetings to discuss audit results and action plans.

Qualifications:

Education:

• Bachelor’s degree in Healthcare Administration, Finance, Business, or related field (or equivalent experience).
• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or similar certification is preferred.

Experience:

• Minimum of 3-5 years of experience in healthcare revenue cycle management, billing, coding, or auditing.
• Experience with Electronic Health Records (EHR) and billing systems.

Skills:

• Strong analytical and critical thinking skills.
• Attention to detail and accuracy in work.
• Excellent communication skills, both written and verbal.
• Ability to work independently and collaboratively in a team environment.
• Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint).

Other Requirements:

• Knowledge of healthcare reimbursement methodologies, including Medicare, Medicaid, and commercial payers.
• Understanding of HIPAA regulations and compliance standards.

Working Conditions:

• This position typically works in an office environment but may require occasional travel to other locations within the organization.
• Standard working hours, with occasional overtime to meet deadlines.