Revenue Auditor

About the role

The Revenue Auditor conducts routine audits of inpatient and outpatient medical charts to ensure clinical documentation aligns with billed services. This role focuses on identifying revenue leakage, underpayments, and missed charges while maintaining compliance with healthcare regulations.

Key responsibilities

• Perform audits on medical charts and verify documentation matches billed services.
• Review and maintain the Charge Description Master (CDM) for accurate pricing and code integrity.
• Identify revenue leakage, underpayments, and missed charges, implementing corrective workflows.
• Analyze insurance claim denials, determine root causes, and collaborate with billing and coding teams to prevent future rejections.
• Ensure compliance with CMS guidelines, OIG regulations, HIPAA, and national and local coverage determinations.
• Educate and train clinical staff, physicians, and coders on documentation and billing requirements.

Required profile

• Experience auditing inpatient and outpatient medical records.
• Knowledge of Charge Description Master maintenance and healthcare coding standards.
• Understanding of CMS, OIG, HIPAA, NCD, and LCD regulations.
• Ability to analyze claim denials and develop process improvements.