Revenue Integrity Audit Coordinator

Overview

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Location : Altru Family Medicine Center, 1380 S. Columbia Rd., Grand Forks, ND 58201

Pay Range : $17.07 - $25.60

Summary

The Revenue Integrity Audit Coordinator is responsible for reviewing, analyzing, and appealing denials related to DRG (Diagnostic Related Group) validation denials. This role involves validating the coding and clinical accuracy, ensuring proper documentation, and collaborating with other departments to address payer concerns. Key responsibilities include timely investigation of DRG downgrades, submitting appeals, coordinating follow-up actions, and ensuring compliance with regulatory standards. The specialist also plays a critical role in preventing future downgrades by identifying trends and providing feedback to improve coding and clinical documentation practices.

Essential Job Functions

• Reviews DRG validation denials from payers by analyzing denial reasons, conducting thorough medical record and coding reviews, and determining the appropriateness of initial coding and clinical documentation.
• Prepares, documents, and submits comprehensive appeals for DRG denials with clinical evidence, coding guidelines, and regulatory support while monitoring appeal deadlines to ensure timely compliance with payer requirements.
• Collaborates with coding staff to identify and resolve complex DRG denial cases, improves coding accuracy, and works to enhance overall departmental performance in denial prevention.
• Tracks and analyzes DRG denial trends to identify common denial causes, provides feedback to coding and CDI teams for prevention strategies, and implements corrective actions to reduce future occurrences.
• Maintains accurate denial appeal records in designated software including status tracking, timelines, and outcomes while contributing to revenue protection through successful appeal outcomes and reduced financial impact of DRG downgrades.
• Analyzes denial patterns to identify root causes, collaborates on preventive strategies, and proactively addresses internal process discrepancies to prevent future denials.
• Conducts regular clinical documentation audits to ensure compliance with coding, billing practices, and payer requirements while maintaining proper documentation collection to avoid potential denials.
• Develops and implements process improvements for denial prevention including enhanced workflows, improved interdepartmental communication, and technology solutions.
• Provides regular reports and feedback to leadership and relevant departments on denial prevention efforts, identifying areas requiring attention and tracking improvement outcomes.
• Performs other duties as assigned or needed to meet the needs of the department / organization.

Education

Work Experience

Language Requirements

This position requires proficiency in reading, writing, and speaking English to ensure effective communication in the workplace and with patients, families, and team members.

Physical Demands

Weight Demands

Working Conditions

Driving Requirement Definitions

Driving Requirement For This Position

Infrequent Driver

Reference ID : R6514

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