Mountain View Regional
Revenue Integrity Auditor
Las Cruces
,
NM
Full Time
Job Summary
The Revenue Integrity Auditor supports the organization's revenue cycle by investigating and resolving issues that delay billing and impact reimbursement. This role works closely with Coding, Health Information Management (HIM), Ancillary departments, and the Shared Services Center to ensure timely and accurate processing of accounts. The Auditor also helps identify trends, minimize denials, and reduce days in DNFB (Discharged Not Final Billed) by proactively resolving coding, documentation, and charge-related issues.
Essential Functions
The Revenue Integrity Auditor supports the organization's revenue cycle by investigating and resolving issues that delay billing and impact reimbursement. This role works closely with Coding, Health Information Management (HIM), Ancillary departments, and the Shared Services Center to ensure timely and accurate processing of accounts. The Auditor also helps identify trends, minimize denials, and reduce days in DNFB (Discharged Not Final Billed) by proactively resolving coding, documentation, and charge-related issues.
Essential Functions
- Monitors and works the DNFB and Coding Holds reports daily, prioritizing high-dollar and aging accounts.
- Coordinates with ancillary departments and HIM to resolve outstanding issues preventing claims from billing.
- Communicates with clinical departments to obtain missing documentation, clarify charges, or address process delays.
- Collaborates with Coding Managers to return accounts to the appropriate queues for processing.
- Develops and distributes patient-type reports to responsible department leaders to track and resolve unbilled account holds.
- Prepares weekly corporate reporting detailing coding holds, unresolved documentation issues, and top physicians with outstanding documentation.
- Participates in weekly unbilled calls, providing status updates and identifying process barriers.
- Assists in the creation and execution of action plans when unbilled metrics fall below corporate benchmarks.
- Manages HIM support staff responsible for unbilled accounts assigned to the HIM department.
- Resolves issues related to Shared Services Center (SSI) holds, including documentation or charge discrepancies.
- Tracks unbilled alert days and submits daily trending reports to leadership.
- Serves as a resource for hospital departments to ensure documentation meets billing requirements and reduces delays.
- Acts as a backup for HIM leadership when necessary.
- Performs other duties as assigned.
- Maintains regular and reliable attendance.
- Complies with all policies and standards.
- Bachelor's Degree in Accounting, Finance, Health Information Management, Business Administration, or related field required
- 2-4 years of recent experience in Health Information Management, coding, or revenue cycle operations required
- Strong understanding of billing workflows, HIM operations, and revenue cycle processes.
- Proficiency in using DNFB, coding, and billing systems, as well as Microsoft Office (Excel, Word).
- Excellent organizational and time-management skills with attention to detail.
- Ability to work independently with minimal supervision.
- Strong written and verbal communication skills for working with clinical, coding, and operational teams.
- Ability to analyze account data and trends to proactively identify delays and resolution pathways.
- Certified Professional Coder (CPC) required or
- CCS-Certified Coding Specialist required