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Charge Defense Auditor

Finance | Emeryville, CA | Full Time, Contract, and Temporary

Job Description

Charge Defense Auditor 674782

Responsibilities: 

  • Review audit requests to ensure compliance with ‘Conditions for Audit’ section of hospital policy.
  • Schedules audit with outside auditing firms, and determine the focus of audit review.
  • Provide in-depth review and analysis of charges, services and documentation to support “defense” of charges.
  • Coordinate procurement of itemized bills and medical record/charge support documentation.
  • Support and defend hospital charges where appropriate, using clinical knowledge, appropriate regulatory support, Medical Record and other documentation.
  • Meet with the external auditor in an exit interview and mutually agree on a timeframe for issue resolution.
  • Make a determination of “agreement “ or “non-agreement” with external audit findings and determine next steps. This may include charge reversals, rebilling, claim corrections and possibly refunds to the third party.
  • Review audit outcomes with supervisor and Assistant Director before final sign off of audit results.
  • Provide education to ancillary managers and physicians as needed.

Additional responsibilities:

  • Managing DNB and late charge work queues (WQ 9 and 99, respectively).
  • Completes simple coding categories (Attending Physician is Missing, Invalid Attending Provider, and Primary Diagnosis Missing).
  • Assists with maintaining the Timely Filing category on the daily Hold Report.
  • Completes custom billing for cosmetic combination packages.
  • Records billing statuses for HAC cases. 
  • Assists with inpatient billing in the absence of the inpatient biller.

Requirements: 

  • High school graduation, BS preferred.
  • At least 3 years of relevant work experience
  • Strong Excel skills
  • Ability to work with clinicians, ancillary staff and revenue cycle staff to identify critical reimbursement issues and resolve them in an expedient manner.
  • Knowledge of charge system, charge master structure, documentation and coding procedures.
  • Excellent analytical and organizational skills.
  • Excellent interpersonal, verbal and written skills.
  • Current Procedure Coding certification.
  • In-depth knowledge of ICD10, CPT4, HCPC, DRG, ASC, UB Revenue Codes and familiarity with UB04 and 837I billing regulations and requirements.
  • Understanding of HIPAA rules and regulations.   
  • EPIC and EPIC EHR experience highly preferred. 
  • Prior knowledge and experience working with medical records (EHR)
  • CPC preferred

$35-$40 per Hour        Emeryville, CA 94608         4 Month Assignment