OR Biller - Chart Auditor

The Specialist OR Biller / Chart Auditor works under the supervision of the Perioperative Services Director or designee and serves as a subject matter expert for Operating Room Charge capture, billing accuracy, and revenue integrity. This role is responsible for the audit, validation, and reconciliation of intraoperative documentation, supplies, implants, devices and time-based services to ensure all billable components of surgical cases across surgical service lines are accurately captured, posted, and billed across the system. and special ordering regarding supplies, implants, and devices in the operative setting. This position plays a critical role in preventing revenue leakage, supporting compliance, and ensuring alignment between clinical documentation, EMR charge workflows, and downstream billing processes across all perioperative service lines. The Specialist provides guidance and education to OR caregivers and collaborates closely with Revenue Cycle, Supply Chain, Clinical Informatics, Coding, Billing, Purchasing and Finance, as well as Perioperative caregivers across the system in St. Joseph, Maryville, Albany, GI Lab, Cath Lab, Interventional Radiology/Special Procedures.</p

• Audits and reviews operative cases and intraoperative documentation daily to ensure accurate and complete charge capture for procedures, supplies, implants, devices, and time-based services across all surgical service lines alongside preference cards, implant logs, anesthesia records, and case times to validate alignment with posted charges.
• Identifies and resolves missing, duplicate, or incorrect charges, working directly with OR caregivers and ancillary departments to correct variances while ensures surgical cases are finalized and ready for billing in a timely manner.
• Performs charge integrity reviews to confirm that clinical activity translates accurately into billable charges prior to coding and claim submission while monitoring trends in charge variances, revenue per case, and recurring documentation gaps; escalates opportunities for improvement to Perioperative leadership.
• Supports perioperative revenue integrity initiatives by identifying root causes of charge loss and partnering on improvement plans while serving as a key resource for high dollar and implant intensive cases to ensure appropriate reimbursement.
• Collaborates with Clinical Informatics and IT to validate Epic charge routing, OpTime workflows, and interface accuracy related to perioperative billing; Assists with testing and validation when new supplies, implants, procedures, or charge builds are introduced; Troubleshoots charge capture issues related to documentation workflows, system configuration, or interface errors.
• Serves as a billing and charge capture resource for OR caregivers across all system facilities; providing education to clinical staff on documentation elements that directly impact charge capture and reimbursement; Supports standardization efforts related to preference cards, implant documentation, and supply usage workflows.
• Works with sales representatives and vendors to validate implant, supply and special device pricing, invoicing accuracy, and charge master alignment; Obtains pricing for new or unique implants, reorders for critical availability and ensures appropriate payment processes are followed.
• Acts as a liaison between Perioperative Services, Revenue Cycle, Coding, Billing, Supply Chain, Finance and Purchasing to facilitate accurate and compliant billing.
• Monitors and reports trends related to surgical supply usage, charge discrepancies, and revenue opportunities to OR leadership; Participates in audits, regulatory reviews, and internal compliance initiatives as needed.
• Other duties as assigned to support perioperative operations and financial performance.

Education

• H.S. Diploma - High school diploma or general education degree (GED) - Required

Work Experience

• 2 Years - Clinical experience in the intraoperative setting - Required
• 5 Years- Clinical Experience in intraoperative setting - Preferred
• 2 Years - Experience with OR billing, charge capture, auditing, & revenue integrity - Preferred

Licenses and Certifications

• Certified Surgical Technologist (CST) - Required Upon Hire Or
• Licensed Practical Nurse (LPN) - State Licensure - Required Upon Hire Or
• Registered Nurse (RN) - State Licensure/Or Compact State Licensure - Required Upon Hire

Travel Requirements

• Must be able to travel between various system facilities and off-site locations as needed. - Required

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Skills and Abilities

Essential Technical/Motor Skills

• Communicates clearly and concisely.
• Ability to work independently and multi-task as needed.

Interpersonal Skills

• Excellent oral and written communication skills.
• Strong collaboration skills across clinical and non-clinical teams
• Maintains good rapport and professional relationships with caregivers and ancillary departments.

Essential Physical Requirements

• Ability to operate equipment on continuous/repetitious basis such as computer, telephone, fax and copier.
• Multi-skilled responsibilities require sitting, walking and standing.

Essential Mental Abilities

• Comprehend/understand medical terminology, surgical procedures, instrumentation, anatomy, physiology, sequence of events.
• Assess procedural and intraoperative charting and questions discrepancies of chart in relationship to the procedure.
• Ability to analyze and reconcile clinical documentation with billing and charge data
• Knowledge of Epic OR/OpTime workflows and charge capture processes
• Ability to work independently and manage multiple priorities
• Problem-solve, manipulate numbers, adaptability, interpret data, calculate and comprehend.
• Excellent short term and long-term memory.
• Ability to follow system policies and procedures.
• Excellent organizational, analytical, and problem-solving skills.
• Ability to communicate (hear and speak clearly) over the telephone, one-on-one, or in-group settings.
• Speech is clear and concise.
• Ability to see and read for the purpose of a computer screen and various literature on a continual basis.
• Ability to work independently and a demonstrated self-starter.
• Knowledge and experience with a variety of information systems

Essential Sensory Requirements

• Ability to see and hear
• Visually assess paper and electronic data, hear telephone and converse.
• Analytical skills to resolve complex problems requiring the use of scientific, mathematical, or technical principles.

Exposure to Hazards

• Minimal
• Training requires on-site visits to areas of service
• Standard precautions are taken

Other Skills and Abilities

• Ability to have a solid understanding of procedures and surgeries in order to ensure billing is accurate
• Knowledge and experience with a variety of information systems and Internet usage; experience with spreadsheet and word processing software.

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