Revenue Cycle Auditor II

Mount Sinai Medical Center•Miami Beach, FL

1d•Hybrid

About The Position

HYBRID/REMOTE, Must have Florida Residency. The Revenue Cycle Auditor II conducts detailed retrospective and concurrent charge audits to ensure accurate billing, compliant documentation, and proper reimbursement across hospital services. The role identifies under‑ and over‑charges, analyzes audit variances, supports chargemaster accuracy, and manages medical necessity appeal denials. This position works closely with clinical departments, coding teams, outside auditors, and insurance carriers to resolve discrepancies, implement corrective actions, maintain audit tracking reports, and prevent recurrence of charging and documentation errors. Strong knowledge of coding, billing regulations, and hospital revenue cycle operations is essential.

Requirements

CPC or comparable licensure required, CCS Licensure preferred.
CPC and/or CCS Certified or comparable certification
Associate degree
5 years prior work experience in hospital financial or coding or medical claims analysis.

Responsibilities

Performs ongoing/retrospective charge audits of patient records for the purpose of identifying charging and billing weaknesses in the system and possible compliance issues.
Identifies undocumented under and over charges by comparing detailed bill with medical record.
Represents hospital for charge audit functions with Insurance Carriers and their Representatives.
Provides Epic workqueue support to Director
Manages Medicare and insurance medical necessity appeal denials effectively in and in a timely manner.
Provides chargmeaster coding support and coordination with departments to ensure their charge build is appropriate and encompasses all billable services in compliance with coding and billing guidelines.
Receives and orients the outside nurse auditors to hospital routine and procedure and provides them with the medical record and any other information required to perform the audit.
Compares internal charge audit with third party auditor or report and identifies/corrects any differences.
Holds an exit conference with the outside Auditor to compare and confirm audit results.
Takes corrective action when over/under charges are identified by doing credit/debit adjustments and submits request for refunds due to insurance or patient when applicable.
Proactively refers any audit discrepancies to the appropriate departments and makes specific recommendations in order to minimize it's reocurrence.
Analyzes departamental audits findings via reports and charts and presents results to department Director and other appropriate parties.
Follows-up on determinations made as a result of departamental audit resolutions to ensure changes take place within the deadlines agreed upon.
Updates and maintains audit tracking reports such as Revenue Management Dashboard, Insurance Defense Audit, Implant Reviews and S/L Threshold, and summarizes all audit activities on a monthly basis via the Monthly Audit Operations Report.
Assists in the review of the daily departmental late charge and the over $5,000.00 report.
Confers with department to determine causes and assists in taking corrective action.
Performs concurrent reviews for potential catastrophic cases to insure charges are accurate.
Reviews potential implant accounts for compliance with CMS regulations and appropriate pricing in accordance with managed care contract obligations.
Monitors net audit underpayments to ensure health plan's compliance with final audit agreement.
Provides assistance to Business Office staff on medical service, procedures and diagnosis, interpretation of medical terminology, etc.
Makes recommendations, which will minimize charge errors and/or lack of documentation, to each department Director once audit results have been identified.