Revenue Cycle Audit Auditor II, Billing Compliance
Overview
You will own revenue cycle auditing for UPMC across all departments, covering Point-of-Service, Patient Access Hospital POS sites, and specialty-specific accounts receivable. You will report to senior leadership and interact with practice plan administration, driving root-cause analysis and corrective actions. You will manage non-clinical billing holds, support self-audits, and respond to billing inquiries. This role focuses on coding compliance, HIPAA case investigations, and Third Party audit coordination, with direct impact on revenue integrity.
What You'll Do10
- 1Maintain the Identity Theft Log, review inquiries, identify root cause (charge posting, registration, EMPI errors), and correct accounts with departments.
- 2Complete OCPC Investigation Forms for management review and trend Identity Theft volumes by location.
- 3Own non-clinical billing holds for the Audit Team, ensuring accurate and timely claim resolution, and identify improvement trends.
- 4Maintain the Third Party Auditor Calendar and Contact List, including Medical Record view access.
- 5Lead Revenue Cycle Audit Team Coding Reviews for modifier, CPT, and diagnosis issues, and resolve with HIM.
- 6Investigate HIPAA cases, document findings, determine breach notification needs, and initiate notices.
- 7Complete Insufficient Documentation and CHP PFG Diagnosis Verification Requests, ensuring timely resolution per policies.
- 8Maintain the Non Audit Plus Service Account, enter Non Centralized Audits into databases, and distribute Centralized Audits.
- 9Verify Third Party Audit Payer Responsibility, prepare audit bills, UPMC Confidentiality Agreements, and Insurance Audit Settlement sheets.
- 10Support Revenue Cycle self-audits across accounts receivable, registration, scheduling, cash collections, denials, and productivity.
Requirements9
- 1High School or equivalent and 4+ years of healthcare revenue cycle experience including 2 years billing audit experience, or 6+ years related experience.
- 2Analytical problem solving skills and ability to coordinate work and communicate with all management levels.
- 3Knowledge of medical terminology, ICD-9, and CPT coding.
- 4Knowledge of HMO, POS, PPO, Medicare, SNP, CHP, and Medicaid plans.
- 5Detail-oriented with organizational, interpersonal, and communication skills.
- 6Ability to establish priorities, problem solve, and communicate professionally.
- 7Knowledge of MS Office products.
- 8Ability to maintain quality and production standards.
- 9Act 34 clearance required.
Salary Insight
$44 - $73k per year
Location
Required Skills
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