RCM Quality Auditor - Charge Entry

In office role - Shift Hours M-F 730pm IST to 430am IST

The RCM Quality Auditor - Charge Integrity makes sure the services our clients provide become charges, completely and on time. Most of your day is spent working the charge tracking report: finding encounters with no charge, or with a charge that has stalled between the EHR, the interface and the practice management (PM) system, and getting each one to the person who can release it.

You will also audit charge entry accuracy on a sample basis. You will use what you find in both areas to help teams remove the recurring causes of charge lag and charge errors, so the same items stop appearing on the report.

Suggested qualifications

• 2 to 4 years of US healthcare revenue cycle experience in charge entry, charge reconciliation or coding QA.

• Working understanding of how charges move from an EHR to a PM system, including interface concepts such as HL7 charge messages, error queues and code or provider mapping.

• Solid knowledge of CPT/HCPCS, ICD-10-CM, modifiers and NCCI edits.

• Strong Excel skills: pivot tables, XLOOKUP or VLOOKUP, filters and conditional formatting, with comfort handling large daily reports.

• Clear written English for routing items and explaining findings to US-based teams and clients.

• Preferred: CPC, COC or CCS certification; experience with surgical, ASC, Urology or multi-specialty clients; experience with Veradigm practice management products.

Work the charge tracking report

• Daily review. Work the charge tracking report every business day, reconciling scheduled and completed encounters against charges received in the EHR, the interface layer and the PM system.

• Locate the hold. For each missing or delayed charge, identify where it is stuck: unsigned or incomplete provider documentation, coding or charge review queues, failed or errored interface messages, unmapped providers, locations or procedure codes, or claim holds and scrubber edits in the PM system.

• Apply exclusion rules. Apply the approved client-specific exclusion rules so the report shows true exceptions only, including cancellations, no-shows, non-billable visit types, global-period visits, split encounters and services billed by another department or entity.

• Prioritize. Age each open item by charge lag (days from date of service) and prioritize by dollar value, lag bucket, service type (surgical and procedural first) and timely filing deadline.

• Route and track. Send each item to the right owner (provider or clinic staff, coding, charge entry, interface or application support, or the client contact) with the evidence needed to act, and follow it until it is resolved.

• Confirm the release. Verify that released charges posted correctly and completely, and that resubmission or manual entry did not create duplicates.

• Spot system-level failures. Flag interface or build issues that affect more than one encounter, such as a new provider, location, fee schedule or procedure code not set up in the PM system, and escalate them the same day.

Audit charge accuracy

• Audit plan. Run charge entry audits against the approved monthly plan, including random samples, targeted samples (high-dollar encounters, complex specialties, new providers and new clients).

• Source checks. Validate each audited charge against source documents such as EHR encounter, RCE encounters/rules, VPM Import window.

• Charge elements. Verify demographics, insurance, date and place of service, rendering, billing and referring provider, CPT/HCPCS and ICD-10-CM codes and linkage, modifiers, units, charge amounts and authorization numbers, along with NCCI, MUE and LCD/NCD requirements.

• Leakage. Flag missed, late and duplicate charges, and charges entered against the wrong encounter, provider or department.

Find the root cause and fix it

• Root cause analysis. Dig into repeat lag sources and high-impact errors, find the root cause, and work with leadership to help build and track corrective actions (CAPA) such as SOP updates, mapping corrections, provider documentation follow-up and checklist changes. Then confirm that lag days and error rates improved.

• Training support. Spot skill gaps from audit and report data, recommend refresher training, and keep job aids current, including the exclusion rules for each client.

Report, escalate and stay compliant

• Reporting. Publish a daily open-item summary, plus weekly and monthly charge lag reports by client, department, provider, location and cause. Track average lag days, percentage of charges posted within target, unbilled dollars by aging bucket and items at risk of timely filing.

• Escalation. Escalate right away any item near its timely filing limit, any interface outage or message backlog, and any missing high-dollar or surgical charge.

• Staying current. Track annual CPT, HCPCS and ICD-10-CM updates and payer policy changes, and flag updates needed to SOPs, exclusion rules and code mappings.

Help improve the process

• Automation. Recommend changes to report logic, automated encounter-to-charge matching and alerts for failed interface messages, and take part in Lean, Six Sigma and AI-assisted audit pilots.

• Transitions. Support new client go-lives by validating charge flow from the EHR to the PM system in the first weeks, setting the client’s baseline charge lag, and documenting client-specific exclusion rules.

Benefits

Veradigm believes in empowering our associates with the tools and flexibility to bring the best version of themselves to work. Through our generous benefits package with an emphasis on work/life balance, we give our employees the opportunity to allow their careers to flourish. 

• Quarterly Company-Wide Recharge Days

• Peer-based incentive “Cheer” awards

• Tuition Reimbursement Program

To know more about the benefits and culture at Veradigm, please visit the links mentioned below: -

https://veradigm.com/about-veradigm/careers/benefits/ 

https://veradigm.com/about-veradigm/careers/culture/ 

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Veradigm is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse and inclusive workforce.

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