[Hiring] Auditor II, Rev Cyc Audit @UPMC

Role Description

Responsible for the auditing and evaluation of revenue cycle operations across all departments for Point-of-Service, Patient Access Hospital POS sites and specialty specific accounts receivable. Provides support to and interacts with senior leadership, practice plan administration and staff throughout revenue cycle analysis/auditing. Responsible for non-clinical billing holds, supports Revenue Cycle self-audits, and assist in responding to inquiries and complaints.

• Maintain the Identity Theft Log.
• Review inquiries, identify root cause (e.g., charge posting error, registration error, EMPI error).
• Work with departments to correct accounts and charges.
• Complete OCPC Investigation Form when necessary for management review.
• Provide trending of Identity Theft volumes and outcomes by location.
• Assume ownership responsibility for non-clinical billing holds assigned to Audit Team.
• Identify trends and opportunities for improvement for non-clinical claim holds.
• Maintain Third Party Auditor Calendar and Contact List.
• Lead Revenue Cycle Audit Team Coding Reviews focusing on modifier, CPT and diagnosis coding issues.
• Lead investigation efforts associated with cases received via the HIPAA reporting tool.
• Complete Insufficient Documentation and CHP PFG Diagnosis Verification Request Queue(s).
• Ensure timely resolution regarding completed Diagnosis Verification Requests.
• Maintain Non Audit Plus Service Account.
• Assist the Revenue Cycle Health Service Division and other UPMC areas in responding to billing inquiries/complaints.
• Support and contribute to UPMC core values and guiding principles.
• Identify potential or actual risk areas related to billing in response to audit findings.
• Provide training and support to coworkers on appropriate tools and techniques.
• Lead and/or support Revenue Cycle self-audits to ensure compliance of all revenue cycle protocols.

Qualifications

• High School or equivalent and 4 years of healthcare revenue cycle experience including 2 years previous billing audit experience, or 6 years of related experience required.
• Analytical problem solving skills and the ability to coordinate the work of others.
• Knowledge of medical terminology, ICD-9 and CPT coding.
• Knowledge of HMO, POS, PPO, Medicare, SNP, CHP and Medicaid plans.
• Detail oriented with excellent organizational, interpersonal and communication skills.
• Must be able to establish priorities, effectively problem solve, and communicate in a positive professional manner at all times.
• Knowledge of MS Office products.
• Ability to maintain designated quality and production standards.

Licensure, Certifications, and Clearances

• Act 34

Company Description

UPMC is an Equal Opportunity Employer/Disability/Veteran.