Revenue Cycle Auditor II

As Mount Sinai grows, so does our legacy in high-quality health care. Since 1949, Mount Sinai Medical Center has remained committed to providing access to its diverse community. In delivering an unmatched level of clinical expertise, our medical center is committed to recruiting and training top healthcare workers from across the country. We offer the latest in advanced medicine, technology, and comfort in 12 facilities across Miami-Dade (including our 674-bed main campus facility) and Monroe Counties, with 38 medical services, including cancer care, 24/7 emergency care, orthopedics, cardiovascular care, and more. Mount Sinai takes pride in being South Florida's largest private independent not-for-profit hospital, dedicated to continuing the training of the next generation of medical pioneers. Culture of Caring: The Sinai Way Our hardworking, tight-knit community of more than 4,000 dedicated employees fosters an environment of care and compassion. Each member plays a vital role in our collective mission to deliver excellent healthcare through innovation, education, and research. At Mount Sinai, we take pride in our achievements, aiming to be a beacon of quality healthcare in South Florida. We welcome all healthcare professionals to join our thriving community and contribute to our pursuit for clinical excellence. Department: CC019020 Documentation Integrity & Audit Job Description Summary: 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. Position 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. Qualifications License/Registration/Certification CPC or comparable licensure required, CCS Licensure preferred. Education CPC and/or CCS Certified or comparable certification; Associate degree Experience 5 years prior work experience in hospital financial or coding or medical claims analysis. Benefits: We believe in the physical and mental well-being of our employees and are committed to offering comprehensive benefits that fit their personal needs: Health benefits Life insurance Long-term disability coverage Healthcare spending accounts Retirement plan Paid time off Pet Insurance Tuition reimbursement Employee assistance program Wellness program On-site housing for select positions and more! Degree Requirements: Certification: More than 4,000 people work at Mount Sinai Medical Center at more than a dozen locations throughout sunny South Florida, including our flagship, 672-bed hospital on Biscayne Bay at the gateway to Miami Beach. We’re the largest, independent, not-for-profit hospital in South Florida, and we’re the only hospital Healthgrades recognized for four years running as one of the top 5% in the nation. Clearly, clinical excellence is at our core.