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Adventist Health · 1 day ago

Chart Auditor, Full Time, Day Shift-8 Hr, Revenue Management, Glendale

Glendale, CA

Full-time

Onsite

Mid Level

Adventist Health is a faith-based, nonprofit health system serving communities on the West Coast and Hawaii. The Chart Auditor role supports the Revenue Management Department by auditing medical records and clinical documentation to ensure proper patient status placement and accurate coding, while collaborating with various teams to improve documentation quality and compliance.

Elder CareHealth CareHospitalMedicalNon ProfitWellness

Responsibilities

Conducts concurrent audits of active cases to identify documentation and order issues in real time, preventing downstream denials. Applies InterQual or Milliman/MCG criteria to validate patient status decisions and payer medical necessity compliance

Reviews medical records to validate patient placement (inpatient vs. observation) against payer criteria and physician orders. Audits clinical denials to determine root cause, trends, and opportunities for appeal, and recommends actionable prevention strategies. Performs charge audits and account reconciliations to ensure documentation is appropriate, compliant with regulations, and free of denial risk. Provides recommendations for charge corrections and technical assistance in staff training

Identifies barriers to clean claims and timely payment; tracks and trends denials, escalating systemic issues to the Director/Manager. Tracks and trends payer clinical denials, observation hours, and placement errors; prepares reports for Revenue Management leadership. Provides feedback to Coding and CDI teams regarding documentation needed for coding accuracy and DRG assignment

Partners with Case Management, Utilization Management, Medical Officer, and Physician Advisors to ensure accurate clinical documentation and timely status changes. Collaborates in payer escalations and appeal preparation by supplying clinical and documentation findings. Educates providers and staff on documentation, status order accuracy, and denial prevention strategies

Monitors CMS, state, and commercial payer regulatory changes impacting clinical documentation, placement, and observation requirements; integrates updates into audit practices. Demonstrates reliability, responsiveness, and effective follow-up on matters requiring attention

Performs other job-related duties as assigned