Auditor

Job Summary

The Internal Auditor – Revenue Assurance is responsible for ensuring the accuracy, completeness, and integrity of the hospital's revenue cycle by conducting audits across clinical, billing, and financial processes. The role focuses on identifying revenue leakages, ensuring compliance with hospital policies, validating billing accuracy, and recommending process improvements to optimize revenue realization.

Key Responsibilities

Conduct periodic audits of IP, OP, Emergency, Day Care, Pharmacy, Diagnostics, and ancillary service billing. Verify completeness and accuracy of patient charges against clinical documentation and services rendered. Identify revenue leakages arising from missed charges, incorrect tariff application, billing errors, package deviations, and documentation gaps. Review insurance, corporate, CGHS, ECHS, and TPA billing for compliance with contractual terms and payer guidelines. Perform concurrent and retrospective revenue audits to improve billing accuracy. Validate package utilization and ensure correct application of package inclusions and exclusions. Audit discounts, waivers, refunds, credit notes, and manual billing adjustments for policy compliance. Coordinate with Nursing, Operation Theatre, Pharmacy, Laboratory, Radiology, Billing, Finance, and Clinical departments to resolve audit observations. Analyze trends in revenue leakage and prepare root cause analysis with corrective action plans. Ensure compliance with internal controls, statutory regulations, NABH standards, and organizational policies. Prepare audit reports highlighting observations, financial impact, risks, and recommendations. Monitor closure of audit findings and verify implementation of corrective actions. Support internal and external audits related to revenue cycle management. Develop audit checklists and continuously improve audit methodologies.