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Audit analyst

Company Name:
Elliot Hospital
AUDIT ANALYST
Department: REVENUE INTEGRITY
Schedule: 8:00A-5:00P
Shift: Monday - Friday
Hours: 40
Job Summary:
Position Summary:
Reporting to the Manager of Revenue Operations, the Audit Analyst plays an important role in a high-profile group tasked with handling all commercial and government audit processes. The Audit Analyst will perform auditing services for Elliot Health Systems for services in the inpatient /outpatient hospital setting, VNA and HME to ensure that EHS is in compliance with all applicable federal and state laws and regulations as they pertain to coding, billing, and documentation.
To educate, give support, and provide guidance to all EHS providers about compliance, billing, coding and documentation requirements.To perform and monitor Third Party Payor audits by obtaining information relative to all claims audited with regards to policies, departmental practices/processes and procedures; to gather information that would support submitted charges. To review and assist with the Center for Medicare and Medicaid (CMS) Recovery Audit Contractor (RAC) audits.
Responsibilities:

Maintain a system of reporting that provides timely and relevant information on all aspects of audit and compliance issues to management.

Participates in complex projects related to auditing initiatives. Provides support for projects in which senior analysts are involved.

Assist in the tracking and review of RAC audit results.Prepare appeal requests as appropriate.

Perform process review audits of hospital departments, and assist in tracking and review of medical chart review audits.

Draft, revise, and enforce EHS policies and procedures as they apply to auditing functions.

Conduct regular audits to ensure that EHS is coding, billing and documenting completely and accurately and are in compliance with all applicable federal and state laws and regulations.

Perform sensitive and complex investigations into allegations of billing fraud or abuse, as necessary.

Monitor, organize and oversee audit requests from third party payors, including Medicare.

Appeal and defend claims denials, adverse audit results, and sanctions.

Communicate audit results to the Manager of Compliance Audit, the Compliance Committee, and as requested by Senior Management.

Review audit results with providers and educate on areas that may need improvement or attention.

Assist in the development of coding, billing and documentation training and educational materials and perform the training throughout EHS, as necessary.

Assist in the preparation of analysis and report of audit findings and communicate such findings to the appropriate persons.
Education/Experience/Certification/Licenses:
Education:Bachelor s degree or equivalent work experience required.
Experience: Minimum of two (2) to three (3) years auditing and coding experience required.Clinical education and/or utilization review experience strongly preferred.
Certification/Licensure: Dual Hospital and Professional Coding Certification(s) preferred. (CPC, CPC-H, CCS, CCSP); Applicable clinical or professional certifications/licenses such as RN, RT, MT, RPH are highly desirable.
Elliot Health System is an Equal Opportunity Employer and an Affirmative Action Employer.

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