Revenue Assurance - Auditing Analyst

Job description

Role Overview The Revenue Assurance Internal Audit role is responsible for ensuring accuracy, completeness, and integrity of hospital revenue by identifying leakages, strengthening billing controls, and improving revenue cycle processes. The role works closely with operations, billing, and clinical teams to minimize revenue loss and ensure compliance with hospital policies and payer guidelines. Key Responsibilities 1. Revenue Audit & Control • Conduct regular internal audits across OPD, IPD, Pharmacy, Laboratory, and Radiology billing. • Ensure all services rendered are accurately captured and billed (charge capture validation). • Identify instances of under-billing, missed charges, or incorrect billing. 2. Billing Accuracy & Compliance • Review patient bills, packages, tariffs, and discounts for adherence to hospital policies. • Validate package inclusions/exclusions and billing accuracy. • Ensure compliance with insurance, TPA, and corporate billing guidelines. 3. Revenue Leakage Identification • Analyze data to identify revenue gaps, leakages, and process inefficiencies. • Highlight areas of missed revenue opportunities and financial risks. • Recommend corrective and preventive actions to plug revenue leakages. 4. Process Improvement & SOP Implementation • Conduct process audits and identify gaps in revenue cycle management. • Develop and implement standard operating procedures (SOPs) for billing and revenue assurance. • Work with departments to improve charge capture and documentation practices. 5. Stakeholder Coordination • Collaborate with billing, operations, consultants, nursing, pharmacy, and diagnostics teams. • Ensure timely resolution of audit observations and discrepancies. • Support teams in improving compliance and billing accuracy. 6. Reporting & Analytics • Prepare audit reports, dashboards, and revenue analysis for leadership. • Track key metrics such as revenue leakage, recovery, and billing accuracy. • Provide insights and recommendations for continuous improvement. 7. Training & Awareness • Conduct training sessions for staff on billing accuracy, documentation, and compliance. • Create awareness on common errors and best practices in revenue cycle management.