Auditor, Revenue Optimization (remote)

Auditor, Revenue Optimization

Audit medical records to identify missed charges, incorrect coding, and other inconsistencies that result in missed billing opportunities.

Perform Root Cause Analyses and report findings that identify common issues, including over-coding, under-coding and missed billing opportunities.

Retrieves any missing patient information and documentation required for billing.

Complete coding of unbilled records identified through audits.

Prepare reports, executive summaries, and examples of audit findings for presentation and educational purposes.

Assist with Clinical Documentation recommendation, coding guidance research, and the development of coding educational documents.

Conduct ad-hoc audits as needed to provide root cause analysis and recommendations for resolution.

Pre-payment audit : review billing vs documentation, send documentation to the payer, complete necessary charge corrections, and / or identify CDI (Clinical Documentation Improvement) opportunities.

Provide resolution of missing documentation tasks. Retrieve or request necessary documents, code for billing, and data entry.

Provide coding support to cross-functional team inquiries and special projects.

Required Qualifications :

• Minimum 3 years coding experience.
• Must have and maintain an approved coding credential through AAPC (American Academy of Professional Coders) or AHIMA.
• Must have or obtain at least one additional certification (CANPC or CPMA), within 1 year of employment.
• Extensive knowledge of medical billing software and electronic medical records.
• Well-rounded knowledge of CMS requirements claims processing, billing / coding guidelines, and the Revenue Cycle process.
• Proficient PC skills, including Microsoft 365.
• Excel Proficiency to include basic formulas, concatenate, VLOOKUP, and pivot tables).

Preferred Qualifications :

Total Rewards :

The Auditor, Revenue Optimization is responsible for conducting audits and reviewing clinical documentation to ensure proper charge capture, billing in accordance with standard billing policies and compliance standards. This individual is responsible for assisting the team with resolution of coding / billing issues, participating in external / internal audit requests, payer audits, and special projects as needed.

EEO Statement

North American Partners in Anesthesia is an equal opportunity employer.