Charge Auditor (Payor Relations)

Position Summary

The Charge Auditor is responsible for establishing and maintaining an ongoing fee schedule maintenance process within the Payor Relations department. This role audits contracted rate tables against payer agreements, allowables, and internal charge/rate references to detect variances, correct configuration issues, and prevent underpayments or incorrect billing. The Charge Auditor partners with Revenue Cycle Management to resolve reimbursement discrepancies, recover missed payments, and strengthen governance over fee schedule changes. This role delivers audit findings and dashboards that inform leadership decisions on reimbursement accuracy and compliance.

Essential Duties & Responsibilities

Fee Schedule Maintenance & Governance

• Establish and maintain a centralized fee schedule repository covering 100% of active contracts.
• Maintain and review fee schedule data to reflect annual regulatory updates, payer-specific revisions, and bundled payment structures.
• Implement a fee schedule change log and governance process for amendments, escalators, and code updates.

Auditing & Reconciliation

• Review and audit contracted rate tables against payer agreements, allowables, and internal charge/rate references.
• Detect and document variances between billed amounts, contracted rates, and paid amounts across payer categories.
• Partner with RCM to reconcile rate tables to ensure accuracy and consistency, identifying and correcting configuration issues that could lead to underpayments or incorrect billing.
• Investigate underpayments, coding/billing mismatches, and configuration problems in rate tables.
• Implement semi-annual fee schedule audits to validate contracted versus loaded rates and identify reimbursement leakage.

Issue Resolution & Recovery

• Partner with internal stakeholders (RCM) to resolve rate configuration problems, prevent recurring errors, and recover missed reimbursements when appropriate.
• Establish corrective action processes to resolve reimbursement discrepancies and recover underpayments.

Reporting & Stakeholder Engagement

• Build and deliver audit summaries, trend reports, and recommendations to leadership for improving reimbursement accuracy and compliance.
• Monitor effective rates, yield variance, and payment accuracy through monthly dashboards.
• Conduct quarterly business reviews with strategic payors to discuss utilization, operational performance, and reimbursement trends.
• Deliver semi-annual executive reporting on fee schedule performance, audit findings, and reimbursement opportunities.
• Perform other duties as assigned by the Director, Payor Relations.

Qualifications

Education & Experience

• Bachelor's degree in Business, Finance, Healthcare Administration, or a related field required; equivalent experience considered in lieu of degree.
• 3+ years of experience in charge auditing, revenue cycle management, payer contracting, or a related healthcare finance role.
• Experience working with contracted rate tables, fee schedules, and payer reimbursement methodologies.

Knowledge, Skills & Abilities

• Strong analytical and reconciliation skills, with the ability to detect variances and root causes in complex rate data.
• Advanced proficiency in Excel and other data analysis or business intelligence tools.
• Strong cross-functional communication skills, with the ability to partner effectively with RCM.
• Excellent organizational skills, with the ability to build and maintain governance processes and reporting cadences.
• Detail-oriented with the ability to manage multiple priorities and deadlines independently.
• CDT code knowledge is a plus.

Job Category Corporate