DESCRIPTION OF POSITION:

• The Clinical Charge Audit Analyst performs detailed audits of medical records, comparing the medical record documentation against the itemized bill, nursing procedures, and department documented charging practices.

SUPERVISION: Reports directly to the Director of Revenue Management

RESPONSIBILITIES AND DUTIES:

• Proficient in chart review, clinical record information systems, and coding methodologies.
• Ability to understand and interpret medical records, hospital bills, and the charge master.
• Ability to understand all ancillary department functions.
• Ability to understand insurance terms, (HMO/PP, EOB, Stop Loss, etc) and payment methodologies.
• Ability to effectively negotiate with insurance carrier representatives and customers.
• Demonstrate ability to effectively manage multiple projects with innovation, creativity and vision.
• Addressing patient concerns regarding charges and services verbally an in written form in timely fashion (14 day return time from receipt).
• Making monthly observations and recommendations to prevent future cash losses.
• Performing concurrent review of hospital bills to document unbilled, underbilled, and overbilled items/services.
• Preparing reports on audit results, process improvement recommendations and systemic billing errors.
• Submitting charge documents by each facility to reconcile charges to items/services documented in the medical record.

The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.

EDUCATION AND WORK EXPERIENCE

• Clinician desired/preferred. 2-4 year degree (or equivalent experience) in healthcare related field preferred; B.A. degree (or equivalent working experience in healthcare).
• Experience with PCs, word processing, spreadsheet, graphics, and database software applications are desired; Previous auditing experience preferred.
• Strong quantitative, analytical, and organizational skills.
• Ability to communicate orally and in written form.
• Ability to utilize and understand computer technology; Must be team oriented with strong interpersonal skills. Demonstrated ability to communicate and interact with patients, visitors, employees, physicians. Attention to detail.
• Requires emotional stability and maturity; Must be adaptable to change, be decisive, and demonstrate foresight; Exhibits organizational and leadership ability.

Physical Demands/Work Environment

• Requires prolonged periods of sitting with a light amount of lifting of physical records/documents weighing up to 10 pounds.
• Almost 100% of time spent inside the building.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

“Experience Memorial” is more than a slogan, it’s the care we provide our patients and it’s the commitment to our community and our team members. As a nationally certified Great Place to Work, at Lake Charles Memorial Health System you will have the opportunity to be a part of an organizational culture that supports not only exceptional patient care but also the well-being and professional growth of our employees. Join us and be a part of a team where your contributions are valued, your growth is nurtured, and your success is celebrated.

Working at Lake Charles Memorial Health System | Great Place To Work®