Charge Defense Auditor
Finance | Emeryville, CA | Full Time, Contract, and Temporary
Charge Defense Auditor 674782
- 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.
- 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.
- 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