Job Description

Revenue Cycle Auditor-TMCOne
Job CategoryClerical
ScheduleFull time
Shift1 - Day Shift


The Revenue Cycle Auditor-Denials Analyst is responsible for analyzing denials data, creating metrics, as well as tracking and trending denials and results. The Revenue Cycle Auditor-Denials Analyst will identify and trend root causes of denials and report findings as well as implement solutions with billers, coders, MA’s, and front desk staff.  The person in this position will meet with our payers’ provider representatives to resolve incorrect payer denials and denials resulting from changes in payer policy. This person will be a resource for billers and coders working denials as well. Success will be measured by decreasing denial metrics.

•             Experience and expertise in understanding and resolving the root causes of claim denials.

•             Knowledge of creating and maintaining Excel spreadsheets

•             Ability to multitask, prioritize, and manage time efficiently

•             Strong interpersonal skills

•             Outstanding problem-solving and organizational abilities.

•             Experience with Epic is preferred

•             Billing or Coding certification a plus



Provides pre and post payment claim auditing of medical records and associated clinical documentation to ensure proper charge capture, billing in accordance with standard billing policies and reimbursement principles.

Responsible for assisting Revenue Cycle Services, HIM and other departments with resolution of billing issues and/or denials requiring clinical expertise, participating in external audit requests, and special projects as needed.

Provides leadership, direction, and oversight in developing policies and procedures, which support organizational goals and objectives related to employee programs.

Monitors and analyzes current industry trends and issues for potential organizational impact.

Provides clear short- and long-term direction, guidance, and leadership to staff, managers, and executive teams related to revenue benefits and audit findings. advice and recommendations.

Prepares detailed reports that provide a range of data to assist management in evaluating performance and making recommendations.

Provides technical guidance regarding interpretation of state, federal benefits legislation, ensures organizational compliance, and submits regulatory reports as required.

Develops contingency plans and responds to unforeseen circumstances utilizing planned resources.

Effectively assists with staff; interviews, trains; evaluates employee performance; delegates work assignments effectively.

Serves as an audit outcome educator with clinical staff in clinic and department settings

Adheres to TMCH organizational and department-specific safety, confidentiality, values, policies and standards.

Performs related duties as assigned.


EDUCATION:  Completion of a two (2) year college preferred or an equivalent combination of relevant education and experience.

EXPERIENCE: Minimum of three (3) years of experience in hospital or physician setting with extensive Revenue Cycle knowledge.  Minimum of two (2) years of audit experience with a concentration in High Balance and Cost Outlier and/or facility based clinic audits



  • Thorough knowledge of ICD and CPT application, correct practices, and tools utilized within the hospital or healthcare industry is required.

  • Knowledge of computer application software such as Microsoft Office products.

  • Skill in the developing procedures and training material

  • Skills with Health Information Management (HIM), Facility/Physician Billing, Charge Description Master (CDM), Denials Management, Charge Integrity, Financial Analysis

  • Ability to evaluate coding cycle performance and make recommendations for improvement.

  • Ability to read and interpret documents, medical records, contracts, proposals, and related legislation.

  • Ability to analyze, interpret, and prepare and present reports to management.

Application Instructions

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