Sr. Revenue Cycle Compliance Auditor

Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect.

Whether virtual or on campus, Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.

Job Summary:

Works independently performing program, compliance, and risk-based reviews of health care related activities to ensure accuracy of related medical record documentation, coding, billing and policies. Provides written audit summary of findings to include audit recommendations. Conducts revenue cycle investigations to determine and mitigate risk through findings, reports, and recommended actions through an action plan. Responsible for coordinating, developing, and conducting educational training based on audit outcomes. Provides educational training to coders, billers, physicians, and others on documentation requirements and correct coding of inpatient, outpatient, and professional fee services. Applies substantial knowledge of the job and experience to complete a wide range of activities with varying difficulty. Assists Corporate Compliance in maintaining the hospital's Corporate Compliance Program.

Job Requirements:

Education and Work Experience:

• Associate's/Technical Degree or equivalent combination of education/related experience: Required
• Bachelor's Degree: Preferred
• Five years' experience in healthcare coding inpatient, outpatient, rural health care and/or professional fee services: Required
• Five years' experience in auditing in clinic and/or facility revenue cycle: Preferred

Licenses/Certifications:

• Certified Coding Specialist (CCS) or Certified Coding Specialist, Physician (CCS-Phy) or Certified Professional Coder (CPC) or Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT): Required
• Professional Medical Auditor (CPMA) or Certified E&M Coder (CEMC) or Certified E&M Auditor (CEMA) or Certified Documentation Integrity Practitioner (CDIP) or Certified Clinical Documentation Specialist- (CCDS) or CIRCC-AAPC or Radiation Oncology Certified Coder (ROCC): Preferred

Essential Functions:

• Performs comprehensive reviews of health care records for accuracy of revenue cycle billing compliance to include but not limited to medical necessity, compliance risk, review of denials, charge trends, and applied CPT, HCPCS, ICD 10-CM and ICD-10-PCS coding guidelines for inpatient, outpatient, and/or clinic visit encounters that correlates to clinical documentation. Performs a variety of activities in support of internal audits and coordinates external audits including Recovery Auditor Contractors' (RAC), Livanta, Target Probe and Educate (TPE) and Attorney Client Privilege Audits.
• Produces comprehensive audit finding reports that include quantifiable impact, identify areas of opportunity for education, as well as improvement recommendations. Ensures timely dissemination of external audits; generates timely appeals and adheres to all deadlines. Generates RAC reports including but not limited to dollars at risk; Tracks and trends and provides education to coding, operations, and Physicians as needed.
• Communicates clearly (verbally and in written reports or summaries) opportunities regarding proper clinical documentation guidelines, service selection, charge capture and timely submission, healthcare data accuracy and coding principles. Leads and facilitates multi-disciplinary workgroups or projects. Ability to be a project lead to facilitate through all successful action outcomes. Mentors, coaches, and helps to provide on-job training for staff.
• Participates in improving the efficient and effective delivery of the Department's services including promoting the department brand, complying with department and professional standards, participating in department initiatives and internal process improvement projects, and providing input into the enhancement of audit methodologies, workflows and tools.
• Generates audits, utilizing Auditing platform for denials, coding reviews and other risk-based data for department audits. Reviews, researches, references state and federal regulations, payer program memorandum, and other complex, technical and/or legal documents. Participates in annual risk assessment and work plan development processes.
• Performs other job-related duties as assigned.

Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations, including, but not limited to, measles, mumps, flu (based on the seasonal availability of the flu vaccine typically during October-March each year), COVID-19 vaccine (required in CA, HI and OR) etc., as a condition of employment, and annually thereafter. Medical and religious exemptions may apply.