Advanced Auditor

Job description

Job Summary:

The Revenue Auditor is a member of the Revenue Cycle Team. The post holder must have an understanding of hospital coding, billing and reimbursement rates, and other functions related to Revenue Cycle. The incumbent must have knowledge of industry standards and practices related to billing and account receivable management and implement such to ensure compliance with all regulatory requirements. S/he must have extensive knowledge of ICD-10, DRG, and CPT/HCPCS coding systems. The Revenue Auditor runs routine audits of the chargemaster and reports any findings to the team for correction. S/he has demonstrated ability to communicate effectively at all regional and facility levels. The Revenue Auditor is able to investigate, analyze and resolve issues at a high level. The incumbent also has the ability to work efficiently and accurately, and collaborates with other team members to resolve issues.

KEY ROLE ACCOUNTABILITIES:
• Performs weekly audits of the chargemaster to ensure charge accuracy and compliance with all pricing.
• Performs routine audits of each hospital department’s Posted Charges reports in order to maximize charge capture.
• Facilitates development of strategies to improve reimbursement after identifying trends that negatively impact revenue capture.
• Performs routine audits of each hospital department’s Posted Charges reports in order to maximize charge capture and ensure correct reporting of medical services.
• Performs weekly audits of the chargemaster to ensure charge accuracy and compliance with all pricing.
• Liaises with the Analyst – Clinical Billing Compliance and Systems & Contracts Specialist to implement changes in the chargemaster and/or Contract Management that were identified during routine audits.
• Analyzes coding and charging by Outpatient departments following billing guidelines for high riyal departments, i.e.; Emergency Room, Specialty Clinics, procedures performed within the clinics.
• Actively seeks opportunities to positively impact Revenue Integrity workflows and metrics, utilizing experience to identify process improvement needs and to design and implement best practices.
• Works with other departments, physician offices and the Training Specialist to adapt best practices to changing needs within the healthcare environment. Escalates issues to Manager when a department is not responsive to suggestions for preventing revenue loss.
• Maintains an understanding of Sidra’s Choice/No Choice policy and how it relates to patient liability and Contract Management rules within the Cerner system.
• Provides analysis to support Sidra's service/procedure compliance programs.
• Treats colleagues, patients, and visitors with dignity and respect at all times and promotes and maintains effective communication and teamwork
• Adheres to Sidra’s standards as they appear in the Code of Conduct and Conflict of Interest policies
• Adheres to and promotes Sidra’s Values

QUALIFICATIONS, EXPERIENCE AND SKILLS:

ESSENTIAL PREFERRED
Education Bachelor’s Degree in commerce, health information or relevant discipline. Master’s Degree in commerce, health information or relevant discipline.
Experience 3+ years of experience in healthcare compliance, auditing, quality control, finance, and medical affairs. Extensive knowledge of medical devices or the pharmaceutical industry is highly relevant.
• 5 years of experience in a start-up environment.
• Experience with Cerner.

Certification and Licensure Coding certification for hospital and/or physician.
Professional Membership
Job Specific Skills and Abilities
• Requires knowledge of US Medicare regulations and NCCI Edits.
• Timely completion of tasks.
• Proficiency with Microsoft Office suite
• Fluency in written and spoken English
• Clinical knowledge combined with finance knowledge.
• Fluency in written and spoken Arabic is preferred.

Sidra Medicine a healthy population is essential to a strong, prosperous society, and throughout 2020, Sidra continued to provide uninterrupted comprehensive specialist healthcare services for children and young people; and exceptional maternity, gynecology, and reproductive medical services for women, previously unavailable in Qatar and the region.” – H.H Sheikha Moza bint Nasser, Chairperson of Qatar Foundation
Sidra Medicine represents the vision of Her Highness Sheikha Moza bint Nasser who serves as its Chairperson. This high-tech facility is home to world-class patient care,