Clinical Revenue Integrity Auditor

Shift:Monday - Friday, Days
Department: Revenue Management - Remote after Training
Compensation:

* Base Pay Range: $59,321 - $96,761 per year, based on experience

ABOUT THE JOB

MU Health Care is looking for a detail-driven Clinical Revenue Integrity Auditor to join our team. In this role, you'll ensure accurate charge capture and compliance with billing policies through pre- and post-payment audits of medical records and clinical documentation. You'll serve as a trusted resource for resolving complex billing issues, managing third-party audits, and collaborating across departments to maximize reimbursement and uphold integrity. The ideal candidate thrives in a fast-paced environment, demonstrates exceptional problem-solving skills, and brings a strong understanding of clinical documentation and revenue cycle processes. If you're passionate about accuracy, compliance, and making a meaningful impact on financial performance in health care, we want you on our team!

ABOUT MU HEALTH CARE

MU Health Care is proud to be named one of Forbes' Best-in-State Employers seven years in a row, and that's largely a result of the incredible culture and team we've built. At MU Health Care, we have an inspired, hard-working and collaborative environment driven by our mission to save and improve lives. Here, we believe anything is possible and rally around solutions. We celebrate innovation and offer opportunities to be a part of something bigger - to have a voice and role in the work that is serving our community and changing the field of medicine.

Our academic health system - the only in mid-Missouri - is home to seven hospitals, including the region's only Level 1 Trauma Center and region's only Children's Hospital, as well as over 90 specialty clinics. Here you can define your career among our many clinical and nonclinical positions - with growth, opportunity and support every step of the way.

Learn more about MU Health Care.

Learn more about living in mid-Missouri.

EMPLOYEE BENEFITS

* Health, vision and dental insurance coverage starting day one

* Generous paid leave and paid time off, including nine holidays

* Multiple retirement options, including 100% matching up to 8%and full vesting in three years

* Tuition assistance for employees (75%) and immediate family members (50%)

* Discounts on cell phone plans, rental cars, gyms, hotels and more

* See a comprehensive list of benefitshere.

DETAILED JOB DESCRIPTION

Reviews all in-house organ donor bills to identify charges related to organ procurement, care provided, makes adjustments to the patient's account and transfers appropriate charges to the transplant program organ procurement account. Also performs other internal charge audits as necessary (example: charges related to a worker's compensation injury vs. health related charges, Risk Management and Patient Relations cases).

Responsible for managing billing audits requested for audit by third party payers, government agencies and outside auditors which includes; pre audit review of medical record to billing record, prior to onsite/offsite audit. This involves providing information to third party payers and outside auditors about charging practices, coding documentation conventions as well as billing policies and procedures. Responsible for enforcing those policies with insurers and/or review company including pre-payment requirements. This role coordinates on-site audits, negotiates settlement of audit outcomes.

Researches and resolves charge concerns identified through third party audit tools/software.

Audits medical record to billing record on other initiatives as assigned by management.

Performs a variety of tasks to assist Hospital Patient Accounts in resolving charge questions and inquiries, identification of charges per guidelines for various billing requirements, pre-pay charge reviews, hold bills etc.

Performs variety of tasks to identify, trend, monitor and report findings from various documentation and charge views.

Reviews all Medicaid outpatient to inpatient visits to identify charges related to outpatient visit and makes adjustments to the patient's account and transfers appropriate charges to the outpatient claim to maximize reimbursement.

REQUIRED QUALIFICATIONS

Bachelor's degree in Nursing, Medical Records, Hospital Administration, Business, Finance or a combination of education and experience from which comparable knowledge and abilities can be acquired is required.

Minimum of 5 years of related healthcare experience required.

PREFERRED QUALIFICATIONS

Certified Professional Coder (CPC), Certified Professional Coder-Hospital (CPC-H), Registered Health Information Administrator (RHIA), Registered Health Information Technologist (RHIT), LPN, or RN are preferred.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met with or without reasonable accommodation. The performance of these physical demands is an essential function of the job. The employee may be required ambulate, remain in a stationary position and position self to reach and/or move objects above the shoulders and below the knees. The employee may be required to move objects up to 10 lbs.

The University of Missouri is an Equal Opportunity Employer.