VCU Health System Revenue Cycle Auditor in Richmond, Virginia

Revenue Cycle Auditor

Req. #:

55127

Department:

Revenue Integrity

Location:

1601 Willow Lawn Drive, Ste 275, Richmond, VA 23230

Schedule:

Full time

Shift:

1: Days

Hours:

Job Details:

  • Bachelors degree is required

VCU Health System's Revenue Integrity Department is seeking a full time Revenue Integrity Auditor to perform extensive record reviews and audits (prospective of payment) to ensure coding compliance and to monitor data Communicate and defend third party payer or payer contracted audits and ensure clinical research charging compliance. Provide information to third party payers, outside auditors, and clinical research sponsors about charging practices, coding documentation conventions as well as billing policies and procedures. Enforce charging/coding policies with payers and/or their audit company representatives, as well as clinical research protocols. Identify and work to resolve charge issues to ensure accurate and complete billing and documentation practices and review third party payer reimbursement denials based on documentation, billing accuracy, National Clinical Trail (NCT) number, medical necessity, coding and modifier relatedness issues. Evaluate data from the audits to identify and improve billing and documentation. Work collaboratively with Care Coordination, Health Information Management, and clinical departments to respond to Office of Inspector General (OIG), Department of Justice (DOJ), Medicaid Integrity Coordinator (MIC), Recovery Medicare Audit Contractor (RAC), CERT, and other commercial payer directed audits. Routinely interact with clinical research sponsors.

Responsibilities

Communicates effectively with internal clinical and non-clinical departments at all team member levels.

Researches, organizes, analyzes, and synthesizes data.

Manages multiple and competing task.

At all times, ensures clinical research compliance.

Sets goals and objectives, prioritizes work and uses available resources efficiently and effectively.

Responsible for quality improvement initiatives, audits, and department query initiatives.

Qualifications

Required

Bachelor's Degree in Health Care Administration, Business Administration, Nursing or other related field from an accredited institution

Five (5) years of medical records review and/ or coding experience in healthcare setting.

Two (2) years Revenue Cycle auditing experience.

Proficient in Microsoft applications to include Word, Excel, PowerPoint and Outlook

Preferred

Seven (7) years of medical record review/coding experience in an acute care medical facility

One (1) year supervisory/management experience

EOE/M/F/Vet/Disabled

Qualified applicants will receive consideration for employment without regard to their protected veteran or disability status.

HR Use Only:

PTO