Charge Capture Auditor

Charge Capture Auditor

The Charge Capture Auditor is responsible for reviewing, validating, and auditing clinical charges to ensure accurate charge capture, coding compliance, and optimal reimbursement. This role works closely with clinical departments, coding teams, revenue cycle operations, and providers to identify missed charges, billing discrepancies, and process improvement opportunities while maintaining compliance with regulatory and payer requirements.

The ideal candidate has strong knowledge of healthcare revenue cycle operations, medical coding principles, charge master structures, and applicable billing regulations.

Key Responsibilities

• Perform routine and targeted audits of charge capture processes across multiple service lines and departments.
• Review clinical documentation, charge tickets, encounter forms, and system-generated charges to ensure accuracy and completeness.
• Identify missing, duplicate, inaccurate, or unsupported charges and recommend appropriate corrections.
• Validate assigned codes, modifiers, units of service, and billing elements against supporting documentation.
• Ensure compliance with payer guidelines, organizational policies, and federal and state regulations.
• Analyze audit findings to identify trends, root causes, and opportunities for process improvement.
• Collaborate with coding, billing, clinical, and operational teams to resolve charge discrepancies and prevent revenue leakage.
• Monitor adherence to charge capture workflows and provide recommendations to improve efficiency and accuracy.
• Assist with chargemaster reviews and updates to ensure alignment with current coding and reimbursement requirements.
• Prepare audit reports, dashboards, and presentations summarizing findings, risks, and corrective action plans.
• Educate providers and operational teams on charge capture best practices and documentation requirements.
• Support internal and external audits related to revenue integrity and compliance initiatives.
• Maintain confidentiality and security of protected health information in accordance with HIPAA requirements.

Qualifications

Required

• Associate's or bachelor's degree in Nursing or any medical allied course
• Minimum of 2–5 years of experience in charge capture, medical coding, revenue integrity, auditing, or healthcare revenue cycle management.
• Strong knowledge of healthcare billing methodologies, reimbursement models, and revenue cycle processes.
• Working knowledge of ICD-10-CM, CPT, HCPCS, and modifier usage.
• Experience reviewing electronic health records (EHR) and billing systems.
• Proficiency in Microsoft Office applications, particularly Excel.

Preferred

• Professional certification such as CPC, CCS, RHIA, RHIT, CPMA, CRC, or other relevant credentials.
• Experience with chargemaster maintenance and revenue integrity programs.
• Knowledge of Medicare, Medicaid, and commercial payer regulations.
• Familiarity with auditing tools, data analytics platforms, and reporting software.