Auditor II, Rev Cyc Audit at UPMC

United States

<p><strong>Job Summary:</strong><br>Responsible for the auditing and evaluation of revenue cycle operations across all departments for Point-of-Service, Patient Access Hospital POS sites and specialty specific accounts receivable. Provides support to and interacts with senior leadership, practice plan administration and staff throughout revenue cycle analysis/auditing. Responsible for non-clinical billing holds, supports Revenue Cycle self-audits, and assist in responding to inquiries and complaints.<br><br><strong>Responsibilities:</strong></p><ul><li>Maintain the Identity Theft Log. Review inquiries, identify root cause i.e., charge posting error, registration error, EMPI error. Work with departments to correct accounts and charges. Complete OCPC Investigation Form when necessary for management review. Provide trending of Identify Theft volumes and outcomes by location.</li><li>Assume ownership responsibility for non-clinical billing holds assigned to Audit Team, ensuring that all claim holds are worked accurately and timely. Identify trends and opportunities for improvement for non-clinical claim holds.</li><li>Maintain Third Party Auditor Calendar and Contact List making sure all information is current including Medical Record view access.</li><li>Lead Revenue Cycle Audit Team Coding Reviews focusing on modifier, CPT and diagnosis coding issues captured on the Clinical Billng Log. As applicable, work with HIM and Hospital Departments to resolve.</li><li>Lead investigation efforts associated with cases received via the HIPAA reporting tool and/or assigned from management, maintaining documentation of each case file, determining if breach notification is required and initiating any required notices.</li><li>Complete Insufficient Documentation and CHP PFG Diagnosis Verification Request Queue(s).</li><li>Ensure timely resolution regarding completed Diagnosis Verification Requests as outlined in the Revenue Cycle policies and procedures. Identify trends and opportunities for improvement in the diagnosis code review process.</li><li>Maintain Non Audit Plus Service Account. Enter Non Centralized Audits into the department databases. Review and distribute Centralized Audits when necessary. Verify Third Party Audit Payer Responsibility has been met per Third Party Chart Audit Process. Complete necessary documentation, post collection status code, prepare audit bill, UPMC Confidentiality Agreement and UPMC Insurance Audit Settlement Review Sheets.</li><li>Assist the Revenue Cycle Health Service Division and other UPMC areas in responding to billing inquiries/complaints which require a coding, charge description master or billing compliance understanding.</li><li>Support and contribute to UPMC core values and guiding principles and abide by all UPMC departmental policies, procedures and goals in the process of performing all job responsibilities. Incorporates acts of dignity and respect in daily interactions.</li><li>Identifies potential or actual risk areas related to billing in response to audit findings regarding internal and external audits. Assists with corrective action plans and communicates pertinent findings to appropriate UPMC areas.</li><li>Provide training and support to coworkers on appropriate tools and techniques related to Audits, Billing Holds, Identity Thefts, DVR's and External Back-End Billing Office HIPAA related issues.</li><li>Lead and/or support Revenue Cycle self-audits to ensure compliance of all revenue cycle protocols, which may include auditing the following: acounts receivable, registration, referrals, scheduling, cash collections, denials and productivity.</li></ul><br><br><ul><li>High School or equivalent and 4 years of healthcare revenue cycle experience including 2 years previous billing audit experience, or 6 years of related experience required.</li><li>Analytical problem solving skills and the ability to coordinate the work of others and communicate effectively with all levels of management required.</li><li>Knowledge of medical terminology, ICD-9 and CPT coding.</li><li>Knowledge of HMO, POS, PPO, Medicare, SNP, CHP and Medicaid plans.</li><li>Detail oriented with excellent organizational, interpersonal and communication skills.</li><li>Must be able to establish priorities, effectively problem solve, and communicate in a positive professional manner at all times.</li><li>Knowledge of MS Office products.</li><li>Ability to maintain designated quality and production standards.<br><br><strong>Licensure, Certifications, and Clearances:</strong><br>&nbsp;</li><li>Act 34</li></ul><p><br><strong>UPMC is an Equal Opportunity Employer/Disability/Veteran</strong></p>