The Role
Audits inpatient and outpatient charts to validate documentation and billed services, maintains the Charge Description Master, identifies revenue leakage and missed charges, analyzes claim denials, and ensures compliance with CMS, OIG, HIPAA, NCD, and LCD requirements. Collaborates with billing and coding teams to improve workflows and prevent rejections, while educating clinical staff, physicians, and coders on documentation and billing regulations.
Summary Generated by Built In
- 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.
Skills Required
- Knowledge of CMS guidelines and OIG regulations
- Knowledge of HIPAA requirements and NCD/LCD coverage determinations
- Ability to audit inpatient and outpatient medical charts
- Experience reviewing billing, coding, claim denials, and revenue leakage
- Ability to maintain and review a Charge Description Master
- Ability to educate clinical staff, physicians, and coders on documentation and billing requirements
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The Company
What We Do
Madre Integrated Engineering is a multinational triangular employment and outsourcing corporation headquartered in Qatar, specializing in providing global talent for projects and offering facility management solutions.
