Perform routine audits on inpatient and outpatient medical charts to verify that clinical documentation accurately matches billed services.
Review and maintain the Charge Description Master (CDM) to ensure accurate pricing, active codes, and structural integrity.
Identify revenue leakage, underpayments, and missed charges, and implement corrective workflows to capture lost revenue.
Analyze insurance claim denials to identify root causes and collaborate with billing and coding teams to prevent future rejections.
Ensure strict compliance with CMS guidelines, OIG regulations, HIPAA, and both national (NCD) and local (LCD) coverage determinations.
Educate and train clinical staff, physicians, and coders on proper documentation requirements and billing regulations.

Competências necessárias

Inpatient and Outpatient Medical Chart AuditingClinical Documentation and Billed-Service ValidationCharge Description Master (CDM) MaintenanceCharge Pricing and Code Accuracy ReviewRevenue Leakage and Missed-Charge AnalysisUnderpayment IdentificationInsurance Claim Denial Root-Cause AnalysisCorrective Workflow DevelopmentCMS and OIG Regulatory ComplianceHIPAA ComplianceNCD and LCD Coverage Determination ApplicationClinical Documentation and Billing EducationCross-Functional Collaboration with Billing and Coding Teams

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