Revenue Cycle Auditor Jobs

Revenue Cycle Auditor (Must live in Florida)

As Mount Sinai grows, so does our legacy of caring

Located in the heart of Miami Beach, overlooking the breathtaking intracoastal waterway, Mount Sinai Medical Center is dedicated to providing exceptional health care to our diverse community enhanced through innovation, technology, teaching, and research.

Mount Sinai is South Florida's largest private independent not-for-profit hospital with 672 beds, and a tight-knit community of more than 4,000 employees.

We provide world-class care:

• The BEST cardiac surgery survival rate in Florida
• A pioneer in innovative medical research in areas such as cardiology, cancer, memory disorders and pulmonary diseases
• A new seven-story Surgical Tower with 154 all-private rooms and patient centered technology promotes an exceptional patient experience
• Named one of America's 250 Best Hospitals for 2020 and 2021 by Healthgrades, positioning Mount Sinai among the top 5% of hospitals in the nation for overall clinical excellence.

Position Responsibilities:

• Takes corrective action when over/under charges are identified by doing credit/debit adjustments and submits request for refunds due to insurance or patient when applicable.
• Monitors net audit underpayments to ensure health plan's compliance with final audit agreement.
• Performs concurrent reviews for potential catastrophic cases to insure charges are accurate.
• Provides chargmaster coding support and coordination with departments to ensure their charge build is appropriate and encompasses all billable services in compliance with coding and billing guidelines.
• Reviews potential implant accounts for compliance with CMS regulations and appropriate pricing in accordance with managed care contract obligations.
• Updates and maintains audit tracking reports such as Revenue Management Dashboard, Insurance Defense Audit, Implant Reviews and S/L Threshold, and summarizes all audit activities on a monthly basis via the Monthly Audit Operations Report.
• Provides assistance to Business Office staff on medical service, procedures and diagnosis, interpretation of medical terminology, etc.
• Manages Medicare and insurance medical necessity appeal denials effectively in and in a timely manner.
• Follows-up on determinations made as a result of departmental audit resolutions to ensure changes take place within the deadlines agreed upon.
• Holds an exit conference with the outside Auditor to compare and confirm audit results.
• Compares internal charge audit with third party auditor or report and identifies/corrects any differences.
• Represents hospital for charge audit functions with Insurance Carriers and their Representatives.
• Assists in the review of the daily departmental late charge and the over $5,000.00 report. Confers with department to determine causes and assists in taking corrective action.
• Provides Epic work queue support to Director
• Analyzes departmental audits findings via reports and charts and presents results to department Director and other appropriate parties.
• Performs ongoing/retrospective charge audits of patient records for the purpose of identifying charging and billing weaknesses in the system and possible compliance issues.
• Makes recommendations, which will minimize charge errors and/or lack of documentation, to each department Director once audit results have been identified.
• Identifies undocumented under and over charges by comparing detailed bill with medical record.
• Receives and orients the outside nurse auditors to hospital routine and procedure and provides them with the medical record and any other information required to perform the audit.
• Proactively refers any audit discrepancies to the appropriate departments and makes specific recommendations in order to minimize it's recurrence.

Qualifications:

• CPC or comparable licensure required, CCS Licensure preferred.
• CPC and/or CCS Certified or comparable certification; Associate degree
• 5 years prior work experience in hospital financial or coding or medical claims analysis.

Benefits:

We believe in the physical and mental well-being of our employees and are committed to offering comprehensive benefits that fit their personal needs. Our robust employee benefits package includes:

• Paid time off
• Health benefits
• On-site housing for selected positions and more!
• Healthcare spending accounts
• Wellness program
• Employee assistance program
• Retirement plan
• Long-term disability coverage
• Life insurance
• Tuition reimbursement