Revenue Optimization Auditor

This is a fully remote position, open to applicants in Florida.

📋 Description

• Review medical records to pinpoint missed charges, coding errors, and other discrepancies that may lead to lost billing opportunities.

• Conduct Root Cause Analyses and document findings related to over-coding, under-coding, and unbilled charges.

• Gather any missing patient information and documentation necessary for billing processes.

• Finalize coding for unbilled records identified during audits.

• Create reports, executive summaries, and examples of audit findings for presentations and educational initiatives.

• Support Clinical Documentation recommendations, research coding guidance, and assist in the creation of coding educational materials.

• Perform ad-hoc audits and offer root cause analysis along with recommendations for solutions.

• Assess billing in relation to documentation for pre-payment audits, send necessary documentation to payers, make charge corrections, and highlight CDI opportunities.

• Address missing documentation tasks through retrieval or requests, billing coding, and data entry efforts.

• Offer coding support for inquiries from cross-functional teams and special projects.

• Carry out audits and evaluate clinical documentation to guarantee accurate charge capture and compliant billing.

• Assist in resolving coding/billing issues, responding to external/internal audit requests, payer audits, and special projects.

⛳️ Requirements

• At least 3 years of coding experience.

• Must possess and maintain an approved coding credential from AAPC (American Academy of Professional Coders) or AHIMA.

• Required to have or obtain at least one additional certification (CANPC or CPMA) within one year of employment.

• Comprehensive understanding of medical billing software and electronic medical records.

• In-depth knowledge of CMS requirements, claims processing, billing/coding guidelines, and the Revenue Cycle process.

• Strong PC skills, including proficiency in Microsoft 365.

• Expertise in Excel, including basic formulas, concatenate, VLOOKUP, and pivot tables.

• Previous coding experience in Anesthesia or General Surgery is preferred.

• Familiarity with Clinical Documentation compliance and regulatory requirements is preferred.

🏝️ Benefits

• Paid Time Off

• Health insurance

• Life insurance

• Vision insurance

• Dental insurance

• Disability insurance

• AD&D insurance

• Flexible Spending Accounts/Health Savings Accounts

• 401(k)

• Leadership and professional development opportunities