We have an exciting opportunity to join our team as a Clinical Charge Auditor - Revenue Management.
This position performs detailed audits of inpatient or outpatient medical accounts, comparing the medical record documentation with the itemized bill, nursing procedures, and department documented charging practices. This position coordinates and reports audit outcomes regarding charge errors, percentage of savings or losses for the facility, data processing errors, the performance of the hospital charging system as well as documentation and justification within the medical record and itemized bill.
Communicates and works with all internal and external customers.
Liaises with other hospital departments and serves as a point of contact for charge capture improvement opportunities.
Adheres to established productivity standards, participates in departmental performance improvement activities and work level.
Prepares reports and executive summaries as required by management regarding audit results, process improvement recommendations, and systemic billing errors.
Investigates and documents any potential for new programs and product development.
Creates/updates and/or maintains charge protocol manuals for each service area reviewed. Seeks information necessary to accurately complete all aspects of the job requirements.
Performs concurrent review of hospital bills to document unbilled, under billed, and overbilled items/services. Reviews individual charge procedures related to each case, identifies correct service codes on supplies and/or services. Performs review for carve-out exclusion to identify specific prosthetics, orthotics, and other implantable devices.
Identifies compliance risks and financial opportunities based on chart reviews.
Participates in and/or leads inter-departmental process improvement initiatives.
Must have a Bachelor's Degree (or equivalent) in Nursing, health-related field, Accounting, Finance, Management or related field and a minimum of 2 years of related experience, or an equivalent combination of education and work experience.
Experience with PCs, word processing, spreadsheet, graphics, and database software applications are desired.
Strong quantitative, analytical Interpersonal and communication skills.
Proficient in payment review systems, hospital information systems, clinical record information systems, and some coding methodologies.
Ability to understand and interpret medical records, hospital bills, and the charge master along with the ability to understand all ancillary department functions.
Ability to understand insurance terms (i.e. HMO/PPO, EOB, stop loss, etc.) and payment methodologies and to effectively negotiate with insurance carrier representatives and customers.
Knowledge of regulatory agencies requirements (JCAHO, CMS & Medicaid) and remain current on new regulations, policies and procedures.
RN or other applicable clinical license preferred.
Previous auditing experience preferred.
Qualified candidates must be able to effectively communicate with all levels of the organization.
NYU Langone Health provides its staff with far more than just a place to work. Rather, we are an institution you can be proud of, an institution where you'll feel good about devoting your time and your talents.
NYU Langone Health is an equal opportunity and affirmative action employer committed to diversity and inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration without regard to race, color, gender, gender identity or expression, sex, sexual orientation, transgender status, gender dysphoria, national origin, age, religion, disability, military and veteran status, marital or parental status, citizenship status, genetic information or any other factor which cannot lawfully be used as a basis for an employment decision.
NYU Langone Health, a world-class patient-centered integrated academic medical center, is one of the nation's premier centers for excellence in clinical care, biomedical research, and medical education. Located in the heart of Manhattan, NYU Langone is composed of four hospitals – Tisch Hospital, its flagship acute care facility; Rusk Rehabilitation; the Hospital for Joint Diseases, one of only five hospitals in the nation dedicated to orthopaedics and rheumatology; and Hassenfeld Children's Hospital, a comprehensive pediatric hospital supporting a full array of children's health services across the medical center – plus the NYU School of Medicine, which since 1841 has trained thousands of physicians and scientists who have helped to shape the course of medical history. The medical center's tri-fold mission to serve, teach, and discover is achieved 365 days a year through the seamless integration of a culture devoted to excellence in patient care, education and research. For more information, go to www.nyulangone.org.