Revenue Integrity Audit Coordinator

Company Overview

Shriners Children’s is a family that respects, supports, and values each other. We are engaged in providing excellence in patient care, embracing multi-disciplinary education, and research with global impact. We foster a learning environment that values evidenced based practice, experience, innovation, and critical thinking. Our compassion, integrity, accountability, and resilience defines us as leaders in pediatric specialty care for our children and their families.

Job Overview

Shriners Children's is the premier pediatric burn, orthopaedic, spinal cord injury, cleft lip and palate, and pediatric subspecialties medical center. We have an opportunity for a Revenue Integrity Audit Coordinator reporting into our Corporate Headquarters.

The Revenue Integrity Audit Coordinator is responsible for planning, executing, and follow-up for all Revenue Integrity audit activities for the Revenue Integrity Audit team. This includes all regulatory, program, and payer audits that come to the Revenue Integrity Audit team for review and resolution.

Responsibilities

Responsibilities:

• Under the general guidance of the Revenue Integrity Manager:Serve as the liaison between the external auditors to include external payer audit requests.
• Obtain and evaluate all external audit letters in order to determine and remain in compliance with the time sensitive demands noted in each audit letter.
• Document each audit letter request in the SC internal audit tool and spreadsheet.
• Process scheduling, and communicating with internal business areas to ensure the applicable resources are aware of all external letter requests to ensure timely and thorough response to the letter requests.
• Serve as the liaison between the external nurse auditor and SC internal facilities and business areas of the organization.
• Ensure collection of all medical record documentation, invoices, and other payer requested information has been communicated to the appropriate parties and the request has been completed.
• Ensure secure data transmissions between SC and all external requesting parties comply with HIPAA/HITECH security and privacy standards.
• Monitor responsiveness and timeliness of all external requests for information and follow-up with appropriate team members if requests are untimely, or the requesting party makes further requests.
• Maintain a current inventory of all applicable external audits with a clear understanding of the status of each.
• Obtain and communicate audit responses for inclusion in audit reports.
• Post-audit, coordinate, track, report on and validate closure of all external audit activities.
• Assist with special reviews and other program activities at the request of management in a supporting role.

Qualifications

Experience Required/Preferred

• 5 years in healthcare patient accounting revenue cycle environment required
• A Bachelor's Degree, or equivalent combination of education and experience, is required
• 3 years of Hospital Third Party Collection / AR Receivables preferred in this role.
• Experience with hospital revenue cycle revenue management required
• Experience with EDI Transaction sets including 837I, 837P required
• Knowledge of insurance contract rates and terms required
• Understanding of registration and collections required
• Ability to comprehend payor 835 and paper EOB responses, as well CCI edits, CPT, HCPCS, ICD-10 and revenue codes