Revenue Cycle Audit Coordinator

PURPOSE STATEMENT

The Revenue Cycle Audit & Medical Records Coordinator is responsible for coordinating, retrieving, reviewing, and submitting medical records in response to payer requests, pre-payment reviews, post-payment audits, Recovery Audit Contractor (RAC) audits, Medicare and Medicaid audits, commercial payer audits, and other regulatory or reimbursement-related requests. This position ensures timely and accurate submission of medical documentation to support appropriate reimbursement while maintaining compliance with organizational policies, HIPAA regulations, and payer requirements.

Essential Duties and Responsibilities

Audit Coordination

• Coordinate all incoming medical record requests from insurance companies, government agencies, third-party auditors, and regulatory entities, attorneys.
• Prioritize requests based on payer deadlines and financial impact.
• Maintain an audit tracking log documenting receipt, submission, due dates, and final determination.

Medical Record Retrieval

• Retrieve complete and accurate medical records from the electronic health record.
• Review documentation to ensure all required components are included prior to submission.
• Coordinate with Health Information Management (HIM), Case Management, Coding, Patient Financial Services, and clinical departments when additional documentation is needed.
• Verify documentation is legible, complete, and meets payer requirements.

Record Submission

• Submit medical records through payer portals, secure fax, electronic upload, certified mail, or other approved methods. 
• Ensure submissions meet payer-specific formatting and documentation requirements. 
• Maintain confirmation of receipt and submission documentation. 

Audit Follow-Up

• Monitor audit status through completion.
• Track outstanding requests and follow up with payers as needed.
• Notify Revenue Cycle leadership of high-dollar audits, trends, or potential reimbursement risks.
• Coordinate with Denial Management on adverse determinations requiring appeal.

Reporting & Analytics

• Maintain audit statistics, including: 
• Number of requests received 
• Number completed 
• Turnaround times 
• Dollars at risk 
• Audit outcomes 
• Identify payer trends related to pre-payment reviews and post-payment audits.
• Assist in preparing reports for Revenue Cycle leadership.

Compliance

• Maintain compliance with HIPAA and organizational privacy policies.
• Ensure medical records are released only to authorized entities.
• Maintain confidentiality of protected health information.
• Follow CMS, Medicare, Medicaid, and commercial payer audit requirements.

Other Duties

• Perform additional duties and special projects as assigned to support Revenue Cycle operations and organizational goals.
• Maintain regular and predictable attendance.
• Support the Medical Center’s Mission/Vision/Philosophy positively.

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS

• High school diploma or equivalent.
• Two years of experience in healthcare revenue cycle, patient financial services, health information management, or medical records preferred.
• Experience with insurance audits, RAC audits, ADRs, pre-payment reviews, or payer documentation requests preferred.
• Experience using an electronic health record.
• Knowledge of healthcare reimbursement processes.
• Knowledge of HIPAA and release of information requirements.
• Understanding of payer audit processes.
• Strong organizational skills.
• Excellent written and verbal communication.
• Ability to prioritize multiple deadlines.
• Attention to detail.
• Proficiency in Microsoft Office applications.
• Ability to work collaboratively across multiple departments.

Performance Metrics

• Medical Records Submitted Within Payer Timeframes.
• Audit Turnaround Time.
• Percentage of Requests Submitted Timely.
• Number of Overdue Audit Requests.
• Audit Dollars Protected.
• Audit Tracking Accuracy.
• Documentation Completeness.
• Payer Response Timeliness.

PHYSICAL/MENTAL REQUIREMENTS

• Must be able to sit and stand, intermittent 8 to 10 hours a day.
• Must be able to use standard office equipment, including the telephone and computer keyboard.
• Continuously utilizes manual/bi-manual dexterity, near vision, speech, and hearing.
• Frequently stands, walks, sits and utilizes eye/hand coordination and color definition.
• Occasionally reaches above shoulder, regularly required to lift and/or carry up to 40 lbs.
• Occasionally walks on uneven surfaces.