Revenue Integrity Auditor

THIS IS NOT A REMOTE POSITION

The Revenue Integrity Specialist supports accurate, complete, and timely professional billing for anesthesia services across the Hospital Based Provider Group in Palm Beach County. The specialist identifies missed charges, documentation gaps, coding discrepancies, denial trends, and payment variances; coordinates resolution with anesthesia providers, hospital teams, coders, and billing partners; and strengthens revenue capture while maintaining compliant billing practices.

Responsibilities
Essential Responsibilities

- Reconcile operating room, labor and delivery, endoscopy, and other procedural schedules with anesthesia records and posted professional charges. Investigate missing encounters, duplicate charges, canceled cases, and interface exceptions.

- Review anesthesia records for accurate start and stop times, provider handoffs, overlapping services, and other documentation affecting billable time. Obtain clarification through approved workflows before charge release.

- Validate anesthesia procedure and diagnosis coding, base and time units, provider attribution, and applicable modifiers in collaboration with coding staff. Apply payer-specific requirements for personally performed, medically directed, medically supervised, and CRNA or anesthesiologist assistant services.

- Review documentation supporting medical direction and concurrency, monitored anesthesia care, physical status, and qualifying circumstances. Escalate discrepancies and confirm billing reflects documented services and payer rules.

- Review separately reportable services, including postoperative pain procedures, nerve blocks, invasive monitoring, and obstetric anesthesia, for documentation, bundling edits, and payer-specific payment requirements.

- Manage charge holds and documentation exception queues; follow up with anesthesiologists, CRNAs, and anesthesiologist assistants to resolve incomplete or inconsistent records within established timelines.

- Analyze anesthesia denials, claim rejections, and underpayments. Coordinate corrected claims, appeals, and supporting records with billing teams, and implement changes that prevent recurring errors.

- Compare payments with applicable payer contracts, anesthesia conversion factors, and reimbursement methodologies. Escalate variances and track resolution with revenue cycle leadership.

- Partner with hospital departments, provider enrollment, IT, and external billing vendors to resolve demographic, insurance, rendering provider, place of service, and data transmission issues that affect professional claims.

- Conduct focused audits, maintain findings and corrective action logs, and educate providers and staff on recurring documentation and charge capture issues. Follow approved coding, privacy, and compliance policies.

Qualifications
Required Qualifications

- High school diploma or equivalent; additional education or training in medical billing, coding, health information management, or a related field.

- Three years of professional revenue cycle, coding, billing, auditing, or revenue integrity experience, including at least one year working directly with anesthesia professional claims.

- Working knowledge of anesthesia coding and reimbursement, CPT, HCPCS, ICD-10-CM, anesthesia time reporting, medical direction documentation, concurrency, and payer-specific modifiers.

- Experience reconciling encounters and charges, researching denials, interpreting remittance information, and reviewing documentation for claim accuracy.

- Proficiency with electronic health records, practice management or billing systems, and Microsoft Excel for reconciliations, trend analysis, and reporting.
Preferred Qualifications

- Associate or bachelor’s degree in health information management, healthcare administration, finance, or a related field.

- Certified Professional Coder (CPC), Certified Coding Specialist–Physician-based (CCS-P), or Certified Anesthesia and Pain Management Coder (CANPC) credential.

- Experience supporting a hospital based anesthesia group across multiple facilities and collaborating with outsourced billing partners.

- Familiarity with Medicare, Florida Medicaid, and commercial payer requirements affecting anesthesia professional services.
Knowledge and Skills

- Strong analytical skills and attention to detail; ability to distinguish documentation, coding, workflow, enrollment, and payment issues and identify their underlying causes.

- Clear, professional communication with physicians, anesthesia clinicians, hospital personnel, and billing teams; ability to deliver practical education and follow through on outstanding issues.

- Ability to prioritize work queues, meet deadlines, document actions, and handle protected health information confidentially.

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