Covenant Health

Job Title
Revenue Integrity Auditor
ID
3508093
Facility
Covenant Health Corporate
Department Name
REV INTEGRITY & UTIL

Overview

Covenant Health

Revenue Integrity Auditor 

Part Time, 48 Hours Per Pay Period, Day Shift

 

Position Summary: Performs complex level professional internal auditing work. Work involves leading or conducting process, financial, and compliance audit projects for Covenant Health entities as they relate to charging, coding, documentation and billing compliance. Also provides consulting services to the organization's management and staff and may coordinate requested investigations. Maintains all organizational and professional ethical standards and works with Covenant leaders to coach, mentor, and train department staff. Works independently under limited supervision with significant latitude for initiative and independent judgment. Reports to the Revenue Integrity Manager.

 

 

 

Responsibilities

 

  • Identifies and evaluates company risk areas and provides auditing procedures related to documentation and reimbursement to include: documenting client processes and procedures; assessing risks and adequacy of related manual and automated internal controls; developing criteria; reviewing and analyzing findings. Also provides corporate oversight of any current departmental audit programs.
  • Reviews ADR log, Appeals Database and Payor websites to identify audit issues and proactively
  • Coordinates with appropriate parties the complete/ partial payment or repayment of the claims, as described in the Audit Policy, as findings are identified that are either over-payments or underpayments. 
  • Explains charges and charging procedures to third party insurance companies for defense audits as applicable.
  • Works in conjunction with health information management, patient accounting, information systems and other personnel to assist with implementation of solutions to maintain a proper compliance stance.
  • Recognizes situations, which necessitate supervision and guidance, seeking and obtaining appropriate resources.

 

 

 

 

 

 

Qualifications

 

Minimum Education: Must be sufficient to meet the standards for achievement of the below indicated license and/or certification as required by the issuing authority.

 

Minimum Experience:Three (3) to five (5) years’ experience in health care.  Good working knowledge of healthcare billing, Medicare/Medicaid billing guidelines, and other Third Party Payor rules and regulations. Experience in problem solving and analytical reviews. Must be knowledgeable in use of PC's, Windows, Excel and Word Processing. Must have good public relations skills.

 

Licensure Requirements: Current clinical license/registration in the State of Tennessee or certification in field of healthcare related study.  RHIT/RHIA/CPC or clinician with background in provider reimbursement, coding or utilization management preferred.

 

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