HB Revenue Integrity Audit Specialist

Typical pay range: $22.57 - $31.60 per hour, based on experience.

In addition, this role is eligible to work remotely from an approved state by St. Charles (please refer to the list). If you do not reside in an approved state listed (or do not plan to relocate to an approved listed state) we request you do not apply for this particular position.

Approved states by St. Charles: Oregon, Arizona, Arkansas, Florida, Idaho, Missouri, Montana, Nevada, New Mexico, North Carolina, Oklahoma, Tennessee, Utah, and Wisconsin.

About St. Charles Health System:

St. Charles Health System is a leading healthcare provider in Central Oregon, offering a comprehensive range of services to meet the needs of our community. We are committed to providing high-quality, compassionate care to all patients, regardless of their ability to pay. Our values of compassion, excellence, integrity, teamwork, and stewardship guide our work and shape our culture.

What We Offer:

Competitive Salary

Comprehensive benefits including Medical, Dental, Vision for you and your immediate family

403b with up to 6% match on Retirement Contributions

Generous Earned Time Off

Growth Opportunities within Healthcare

Apply Now:  Join our team of dedicated healthcare professionals at St. Charles Health System and make a difference in the lives of our patients.

ST. CHARLES HEALTH SYSTEM

JOB DESCRIPTION

TITLE:                                      Revenue Integrity Audit Specialist         

REPORTS TO POSITION:         Supervisor, System Revenue Integrity

DEPARTMENT:                         Revenue Integrity

DATE LAST REVIEWED:          April 2023

OUR VISION:                            Creating America’s healthiest community, together

OUR MISSION:                         In the spirit of love and compassion, better health, better care, better value

OUR VALUES:                          Accountability, Caring and Teamwork

DEPARTMENT SUMMARY: The Revenue Integrity department provides many services to our multi-hospital and medical group organization focusing on the patient financial experience along the entire continuum of care. Our goal is to deliver a delightful, transparent and seamless experience to our patients and customers that captures and collects the revenue earned by St. Charles Health System (SCHS) in a quality, efficient and timely manner. 

POSITION OVERVIEW: The Revenue Integrity Audit Specialist at St. Charles Health System directs, coordinates, and administers activities and functions relating to the management of the Audit Contractors processes, including but not limited to the Recovery Audit Contractor (RAC) for Medicare and other insurance carriers. This position enters and maintains required data in the designated software application and monitors activities and processes to ensure requirements and deadlines are met. The Revenue Integrity Audit Specialist monitors timeliness of activities including responses and appeals, maintains tracking data, identifies issues and trends of RAC denials, and oversees ongoing education and awareness of RAC compliance, processes, and procedures for the organization. They communicate with hospital staff, provider offices, designated vendor representatives and others as needed for timely and accurate processing of audit contractors’ activities. This position communicates across departments including Coordination of Care, Revenue Cycle, Corporate Compliance, and others as needed and provides reports, updates, and educational information relative to the audit contractor program.

This position does not directly manage any other caregivers.

ESSENTIAL FUNCTIONS AND DUTIES:

Monitors, tracks, and reports on the different government audit activities for SCHS. Provides information and or reports to the appropriate parties including Compliance and Revenue Cycle Leadership.

Personally releases information from the legal medical record to support audit activities. When necessary, contacts outside entities to request records to support and/or appeal findings for services rendered/supplied by SCHS.

Documents necessary account notes in the audited encounters.  Uploads audit informational letters as necessary into the patient’s administrative medical record.

Posts encounter level adjustments based on audit findings to ensure accounts reflect any recoupment(s) made due to audit activity.

Supports Revenue Integrity Leadership in identifying and coordination of key stakeholders to address audit findings and/or to provide feedback/education offered as part of different audit types.

Acts as the point of contact for Medicare and other insurance payers audit activity.

Responsible for writing and submission of appeals. This may include collaboration with appropriate parties to complete appeals letters that require a nurse or physician provider to support medical necessity appeals.

Supports the vision, mission, and values of the organization in all respects.

Supports Value Improvement Practice (VIP- Lean) principles of continuous improvement with energy and enthusiasm, functioning as a champion of change.

Provides and maintains a safe environment for caregivers, patients and guests.

Conducts all activities with the highest standards of professionalism and confidentiality. Complies with all applicable laws, regulations, policies and procedures, supporting the organization’s corporate integrity efforts by acting in an ethical and appropriate manner, reporting known or suspected violation of applicable rules, and cooperating fully with all organizational investigations and proceedings.

Delivers customer service and/or patient care in a manner that promotes goodwill, is timely, efficient and accurate. 

May perform additional duties of similar complexity within the organization, as required or assigned.

EDUCATION:

Required: High School Diploma or GED.

Preferred: Associates degree in a health care or science related field     

LICENSURE/CERTIFICATION/REGISTRATION:

Required: N/A 

EXPERIENCE:

Required: Two (2) years in health care, either in a clinical setting, medical coding, billing or denials. Must be strong and proficient with use of Microsoft office.

Preferred: Strong knowledge in medical terminology. Experience in dealing with third party payers and their audit and denials processes.

PERSONAL PROTECTIVE EQUIPMENT:

Must be able to wear appropriate Personal Protective Equipment (PPE) required to perform the job safely.

ADDITIONAL POSITION INFORMATION:

Skills:

General:

Communication/Interpersonal

Must have excellent communication skills and ability to interact with a diverse population and professionally represent SCHS. 

Ability to effectively interact and communicate with all levels within SCHS and external customers/clients/potential employees.

Strong team working and collaborative skills.

Ability to effectively reach consensus with a diverse population with differing needs.

Ability to work under pressure in a fast-paced environment.

Organizational

Ability to multi-task and work independently. 

Attention to detail.

Excellent organizational skills, written and oral communication and customer service skills, particularly in dealing with stressful personal interactions.

Strong analytical, problem solving and decision-making skills.

Excellent organizational and multi-tasking skills.

Computer

Demonstrated ability and experience in computer applications, use of electronic medical record keeping systems and MS Office.

Schedule Weekly Hours:

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