Revenue Auditor

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.